目的 探讨创伤性鼓膜穿孔自然愈合的穿孔缘形态特征及其临床意义.方法 对82例创伤性鼓膜穿孔患者内镜下动态观察自然愈合过程穿孔缘的形态变化.结果 82例中,随访1周以上69例.伤3h穿孔缘毛糙、锐利;伤6h穿孔缘淤血肿胀;伤第1天穿孔缘逐渐变钝,上皮层有回缩现象;伤第2天穿孔缘肿胀逐渐消退,外翻鼓膜瓣开始坏死发黑;伤第3天起表皮层和纤维层开始有增生现象;第5~6天穿孔缘上皮增生增多,外翻鼓膜瓣结痂;1周后上皮层继续增生.其中,19例小穿孔11~16天时愈合,5例鼓膜钙化患者无纤维层增生,1例大穿孔边缘肉芽组织增生,23天时穿孔愈合.2例上皮层错向移行患者穿孔未愈合,2例感染时新生上皮层被液化.结论 ①根据内镜下创伤性鼓膜穿孔缘的形态特征可推断鼓膜损伤时间,指导临床评估预后;②创伤性鼓膜穿孔缘的外翻或内翻的皱褶鼓膜瓣对穿孔愈合无影响;③上皮错向移行可导致穿孔不愈.%Objective To observe the morphological charaet(c)ristics of nalural healing of the tympanic membrane' perforation by cndoscope and study its clinical significance. Methods The natural healing of the tympanic memhrane' perforation was observed by endoscope in 82 cases. Results During the follow - up of more than a week in 69 cases, it showed that rough edge and sharp - edged in 3h,congestion and swelling in 6h, retraction of the epithelial layer on the fiest post - perforation on the first day. The swelling disappeared gradually and the everted edges began necrosis from the secondday. Hyperplasia of the fibrous and epithelial layers was noted from the thirdday. The epithelial layers was increased and the everted edges became incrustation from the fifth to sixthday. The epithelial layers continued increasing in one week. Among them,the healing time was from 11 to 16 days in 19 small perforation. Five rases of tympanic membrane calcification had no fibrous layers. The proliferation of granuloma formed in one big perforation, and the healing time was 23 days. The epithelial layer migration showed deviation from normal and perforation could not heal in two cases. The epithelial layers was easier to be liquefied in two infection cases. Conclusion ①The morphulogical characteristics of tympanic membrane perforation by endnscope was used to infer injury time of perforation in forensic identification and clinical evaluation. ②The inverted or everted edges did not affect the healing. ③The epithelial layers migration could lead to no healing of tympanic membrane.
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