矽膠片使用於中耳手術

背景：中耳手術之主要目的為重建聽力。因此，如何經由手術建立一個黏膜完整、通氣絕佳且聽小骨振動良好之中耳腔，手術者追求的目標。本文將討論於中耳手術中，由不同型式之矽膠片設計，所導致不同之手術結果。方法：自1989年1月至1995年1月接受中耳手術的病人中，有115名病人於術中置入矽膠片。其中男性病人有49名，女性有66名。病患年齡自19至68歲不等，平均年齡47.2歲。使用矽膠片之厚度、大小及型式，乃根據術中所見病人中耳腔情況而定：矽膠片的大小及形狀以能夠完全覆蓋受損黏膜之區域為原則。同時視病人中耳腔之深淺選用不同厚度之矽膠片，以免太薄太軟的矽膠片容易移位或捲曲；或是太厚之矽膠片佔據太多中耳肉，甚至於太貼近鼓膜因而限制鼓膜動。病人於術後返回門診追蹤其預後情形，以期尋找出最佳型式之矽膠片設計。結果：共有92名病人於術後門診追蹤達半年至2年之久（平均追蹤時間13個月），有68名（73.9%）患者復原良好；另有24名（26.1%）病人發生不同情形之併發症：包括術後發生鼓室積血2名（佔術後併發症8.33%）；發生耳鳴有4名（佔16.67%）；鼓膜再度穿孔有2名（8.33%）；發生術後再沾粘有14耳（58.33% ）及聽力未見改善者2名（8.33%）。我們檢討術後併發症發生的原因發現：矽膠片的大小及放置的位置不當，或是形狀及厚度不當，均是造成術後併發症發生的原因。我們分析不同病人其所產生的併發症，並且尋求其解決之道。結論：矽膠片使用中耳手術中由來已久，其可以有效預防術後中耳組織再沾粘的發生，然而設計不當之矽膠片反而容易導致中耳問題之再發。因此，如何經由更精確之設計，以獲得最大之效益，並避免發生併發症，便是本研究之主要目的。

關鍵字

中耳手術；矽膠片

並列摘要

Background: Hearing restoration is the major goal in middle ear surgery. To obtain this objective, an air-filled and mucosa-lined middle ear space with satisfactorily mobile ossicles should be reconstructed. In this study we eval-uated the effect of silicone sheeting on the condition of the middle ear following tympanoplasty. Methods: From January 1989 through January 1995, 115 patients with adhesive otitis media underwent tympanoplasty with the use of silicone sheeting. There were 49 men and 66 women. Their ages ranged from 19 to 68 with a mean age of 47.2 years. The dimensions of the sheeting were decided according to the condition of the middle ear. The patients were followed postoperatively and side effects resulting from the silicone sheeting were recorded. Results: Ninty-two patients were followed for 6 to 24 months (average: 13 months). Sixty-eight patients (73.9%) completely recovered. However various side effects were noted postoperatively in 24 patients (26.1%): hemotympanum, 2/24 (8.33%); tinnitus, 4/24 (16.6%); ear drum reperfo-ration, 2/24 (8.33%); readhesion of the idle ear, 14/24 (58.33%); and no improvement in hearing, 2/24 (8.33%). Malposition, poor fixation, and inadequate dimensions of the sheeting may have been responsible. We eval-uated these possibilities and managed to solve the problems. Conclusions: Silicone sheeting has been used in middle ear surgery for a long time. It is intended to prevent postoperative readhesion of the middle ear and to enhance successful reconstruction. However, an inadequate design will cause untoward effects. Thus, designing adequate silicone sheet-ing to get maximum benefits and prevent side effects is of prime impor-tance.

並列關鍵字

middle ear surgery ； silicon sheeting

國際替代計量

矽膠片使用於中耳手術

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