CAJ | 학술논문

目的：探讨鼓膜边缘缺失的鼓膜成型方法和注意点。方法39例（48耳，19例男性），均年龄50.92岁(范围26-83岁)，病程均12.5年（范围10-20年）。鼓环部分或大部分缺失。术前平均气骨导差(ABG)30.16±8.76dB (范围13-55dB)，气导（AC）43.64±11.03dBHL（范围22-72dBHL），骨导（BC）13.68±9.47dBHL（范围1-39dBHL）。2006-2013年间手术。一些如保护残余鼓膜前下方关键点被覆上皮和移植的骨膜顶嵌入等确保愈合方法。以及减少电钻噪声刺激、减少听骨位移等预防感音功能受损技术方法。结果48耳随访12月以上。穿孔全部愈合。无面瘫、眩晕、耳鸣等并发症。术后AC27.56±12.19dBHL，GAP12.39±8.54dB与术前相比，U值分别为6.77和10.06，都>u0.01=2.57, p<0.01，差异都有极显著性意义。术后BC13.9±9.95dBHL，与术前相比，U值=0.11<u0.05=1.96, p>0.05，差异没有显著性意义。术后GAP缩小到10dB以内23耳（48%），11-20dB者16耳内（33%）。AC除5耳（10%）外都在40dB以内。结论如果操作技术得当，鼓膜边缘缺失仍能取得满意效果
목적：탐토고막변연결실적고막성형방법화주의점。방법39례（48이，19례남성），균년령50.92세(범위26-83세)，병정균12.5년（범위10-20년）。고배부분혹대부분결실。술전평균기골도차(ABG)30.16±8.76dB (범위13-55dB)，기도（AC）43.64±11.03dBHL（범위22-72dBHL），골도（BC）13.68±9.47dBHL（범위1-39dBHL）。2006-2013년간수술。일사여보호잔여고막전하방관건점피복상피화이식적골막정감입등학보유합방법。이급감소전찬조성자격、감소은골위이등예방감음공능수손기술방법。결과48이수방12월이상。천공전부유합。무면탄、현훈、이명등병발증。술후AC27.56±12.19dBHL，GAP12.39±8.54dB여술전상비，U치분별위6.77화10.06，도>u0.01=2.57, p<0.01，차이도유겁현저성의의。술후BC13.9±9.95dBHL，여술전상비，U치=0.11<u0.05=1.96, p>0.05，차이몰유현저성의의。술후GAP축소도10dB이내23이（48%），11-20dB자16이내（33%）。AC제5이（10%）외도재40dB이내。결론여과조작기술득당，고막변연결실잉능취득만의효과
Objective To report results of myringoplasty for tympanic membranes with marginal perforations. Methods Thirty nine cases (48 ears) treated between 2006 and 2013 were reviewed, including 19 males (mean age=50.92 years, rang?ing from 26 to 83 years) with a mean disease course of otitis media of 12.5 years. All patients presented with tympanic mem?brane perforation affecting part or the entire rim. Mean pre-operation air-bone gap (ABG) was 30.16 ± 8.76 (13-55) dB, with mean air conduction (AC) threshold at 43.64±11.03(22-72)dB HL and mean bone conduction (BC) threshold at 13.68±9.47 (1-39)dB HL. Key surgical techniques included preservation of skin flap anterior and inferior to the tympanic membrane and application of periosteum graft medial to the tympanic membrane. Disturbance to the ossicles and use of drilling were mini?mized to prevent sensorineural hearing damage. Results All 39 cases were followed up for over 12 months and showed healed perforations. There was no postoperative facial palsy, vertigo or tinnitus. Post-operation AC was 27.56 ± 12.19 dB HL with a GAP of 12.39 ± 8.54 dB, significantly improved compared with pre-operative (U= 6.77 and 10.06, respectively, >u 0.01, p<0.01). Post-operation BC was 13.9 ± 9.95 dB HL, similar to pre-operative (U=0.11,<u 0.05, p>0.05). At follow up, ABG was 10 dB or less in 23 ears(48%), and between 11 and 20 dB in 16 ears(33%);and AC was at 40 dB HL or less in all but 5 ears (10%). Conclusion With appropriate techniques, repair can be completed successfully with satisfactory results for tympanic membrane perforation with completely or partially missing rim.