CAJ | 학술논문

目的：观察开放式手术中采用耳后多种自体中胚层组织填充乳突修复耳道后壁的临床效果。方法对慢性化脓性中耳炎和胆脂瘤性中耳炎患者54例实施开放式鼓室成形术，其中采用耳后多种自体中胚层组织填充修复乳突术腔和外耳道后壁患者21例作为观察组；采用自体乳突皮质骨粉、颞肌筋膜以及耳后带蒂肌骨膜瓣填充修复乳突术腔和外耳道后壁患者33例作为对照组。2组术后均随访6个月以上，比较临床效果。结果观察组术后耳道后壁完成上皮化时间为（27？．3±2．3） d，对照组为（33．9±3．2） d，差异有统计学意义（ t ＝2．009， P ＜0．05）。随访6个月，观察组未发现存在耳道过宽病例，形成钝角鼓膜1例（4．8％）；对照组表现耳道过宽23例（69．7％），形成钝角鼓膜13例（39．4％），差异有统计学意义（χ2＝21．74，χ2＝6．31， P ＜0．05）。观察组术后0．5、1．0、2．0 kHz纯音气导听阈均值提高17例（80．9％），对照组提高13例（39．4％），差异有统计学意义（χ2＝7．37， P ＜0．05）。观察组发生并发症1例（4．8％），对照组发生12例（36．4％），差异有统计学意义（χ2＝5．39， P ＜0．05）。结论采用耳后多种自体中胚层组织修复乳突术腔和耳道后壁，对恢复耳道生理结构和功能具有积极意义。
목적：관찰개방식수술중채용이후다충자체중배층조직전충유돌수복이도후벽적림상효과。방법대만성화농성중이염화담지류성중이염환자54례실시개방식고실성형술，기중채용이후다충자체중배층조직전충수복유돌술강화외이도후벽환자21례작위관찰조；채용자체유돌피질골분、섭기근막이급이후대체기골막판전충수복유돌술강화외이도후벽환자33례작위대조조。2조술후균수방6개월이상，비교림상효과。결과관찰조술후이도후벽완성상피화시간위（27？．3±2．3） d，대조조위（33．9±3．2） d，차이유통계학의의（ t ＝2．009， P ＜0．05）。수방6개월，관찰조미발현존재이도과관병례，형성둔각고막1례（4．8％）；대조조표현이도과관23례（69．7％），형성둔각고막13례（39．4％），차이유통계학의의（χ2＝21．74，χ2＝6．31， P ＜0．05）。관찰조술후0．5、1．0、2．0 kHz순음기도은역균치제고17례（80．9％），대조조제고13례（39．4％），차이유통계학의의（χ2＝7．37， P ＜0．05）。관찰조발생병발증1례（4．8％），대조조발생12례（36．4％），차이유통계학의의（χ2＝5．39， P ＜0．05）。결론채용이후다충자체중배층조직수복유돌술강화이도후벽，대회복이도생리결구화공능구유적겁의의。
Objective To observe the clinical effect of the tympanoplasty that using self-post-auricular various meso-dermal tissue on mastoid cavity obliteration and ear canal posterior wall renovation to repair posterior canal wall .Methods Fifty-four cases of chronic suppurative otitis media with cholesteatoma otitis media were received open tympanoplasty , 21 pa-tients received multiple posterior ear autologous mesodermal tissue filling and repair of mastoid cavity and the posterior wall of external auditory canal were enrolled as the observation group;33 patients received pedicled Myoperiosteal flap with autoge-nous mastoid bone cortex , temporal fascia and ears filled with repair of mastoid cavity and the posterior wall of external audito -ry canal were enrolled as control group .After surgery, all patients were followed up for 6 months, clinical effect were com-pared between the two groups .Results In the observation group , after operation , the ear canal wall complete epithelization time was (27.3 ±2.3) d, the control group was (33.9 ±3.2) d, there was significant difference between 2 groups ( t =2.009, P <0.05).After 6 months of follow-up, ear canal too wide case was not found in the observation group , 1 cases of tympanic membrane forming an obtuse angle (4.8%), the control group had 23 cases of ear canal too wide (69.7%), for-ming an obtuse angle of tympanic membrane in 13 cases (39.4%), there was significant difference between 2 groups (χ2 =21.74,χ2 =6.31, P <0.05).0.5,1.0,2.0 kHz pure tone air conduction threshold in the observation group were increased in 17 cases (80.9%), the control group were increased in 13 cases (39.4%), there was significant difference between 2 groups (χ2 =7.37, P <0.05).Observation group occurred complication in 1 cases (4.8%), the control group occurred in 12 cases (36.4%), there was significant difference between the 2 groups (χ2 =5.39, P <0.05).Conclusion Variety of posterior ear autologous mesodermal tissue repair of mastoid cavity and the ear canal wall , postoperative ear size and function is more close to the normal healthy physiological condition than the conventional method , it has positive significance on the re-covery of physiological structure and function of the ear canal .