軟骨嵌入鼓膜成形術之門診手術

Cartilage Inlay Myringoplasty for Outpatients

詹凱傑(Kai-Chieh Chan) ； 黃祥富(Shiang-Fu Huang) ； 蘇仁亮(Jen-Liang Su) ； 吳哲民(Che-Ming Wu)

《台灣耳鼻喉頭頸外科雜誌》 45卷4期 (2010/08) Pp. 103-108

https://doi.org/10.6286/2010.45.4.103

摘要

背景：自從Eavey於1998年首先發展以蝶形軟骨嵌入術(cartilage butterfly inlay technique)修補鼓膜穿孔後，諸多文獻證實此術式對於修補耳鼓穿孔是有效的。相較於目前盛行以顳肌筋膜或軟骨膜爲移植片之內置法或外置法修補耳膜穿孔，以軟骨爲移植片之嵌入鼓耳其成形術並未被廣泛採用。本研究之目的乃在探討國人接受此術式進行門診手術的結果，並加以討論。
方法：以病歷回溯整理方式，收集本科自2008年5月至2008年8月間，針對中、小型鼓膜穿孔之乾耳患者，施行門診手術，在局部麻醉方式下，採耳屏軟骨－軟骨膜(cartilage-perichondrium)爲移植片經耳道進行嵌入鼓膜成形術，統計其術後鼓膜補妥率(take rate)及比較術前及術後之聽力結果。
結果：共有23名患者（24耳），小型穿孔及中型穿孔分別有19及5例，術後門診追蹤3至6個月，平均爲4.7月。鼓膜補妥成功者計21耳(87.5%)，失敗者有3耳(12.5%)，分別爲軟骨逐出(extrusion)2例，鼓膜再次穿孔(re-perforation)1例。術後純音聽力平均閾值(500, 1000, 2000 Hz)較術前改善13.4 dB，若以術後聽力氣導閾值較術前改善10dB以上，視爲聽力進步(hearing improvement)，則在術後鼓膜補妥成功之21耳中，計有11耳(52.4%)。 結論：軟骨嵌入鼓膜成形術對於修補中、小型鼓膜穿孔爲一可行的門診手術，因此可提供耳科醫師執行鼓膜修補手術時之另一選擇。

關鍵字

軟骨移植片 ； 嵌入鼓膜成形術

並列摘要

BACKGROUND: Eavey first introduced a butterfly cartilage inlay technique for closure of tympanic membrane perforation in 1998. Numerous reports have confirmed it is an effective method in repairing eardrum perforation. Compared with the popular myringoplasty techniques which include either an underlay or overlay approach using temporalis fascia or perichondrium, the cartilage inlay myringoplasty is not widely used in Taiwan so far. The aim of this study was to investigate the results and effectiveness of this technique in the c10sure of eardrum perforation in Taiwanese patients.
METHODS: This retrospective study enrolled 23 outpatients (24 ears) who underwent myringoplasties with a transcanal approach using a tragus cartilage-perichondrium graft to fit the tympanic membrane perforation under local anesthesia. The postoperative results of the graft ”take rate” and hearing improvement were analyzed.
RESULTS: There were 23 cases (24 ears) in our study in which 19 were small-sized and 5 were medium-sized. The postoperative follow-up period ranged from 3 to 6 months and the average was 4.7 months. The graft ”take rate” was 87.5% (21/24) at the end of the follow-up period. There were 3 failures, 2 of these were due to cartilage extrusion and 1 was due to re-perforation. Improvement of postoperative air conduction by 10 dB was accepted as hearing improvement which was achieved in 52.4% of 21 successful graft take ears with an overall mean improvement of 13.4 dB.
CONCLUSION: Cartilage inlay myringoplasty is an office-based feasible procedure for closing small to medium-sized tympanic membrane perforations. It could be an alternative for otologists when performing myringoplasties.

並列關鍵字

cartilage graft ； inlay myringoplasty