耳内镜与显微镜下夹层法修补鼓膜大穿孔的疗效比较

冀庆军;柴伟;黄辉;何苗;李大鹏;孙敬武;

1:安徽医科大学附属省立医院耳鼻咽喉头颈外科

2:安徽省亳州市人民医院耳鼻咽喉头颈外科

3:中国科学技术大学附属第一医院耳鼻咽喉头颈外科

摘要
目的比较耳内镜下与显微镜下采用耳屏软骨-软骨膜夹层法鼓膜成形术治疗鼓膜大穿孔的疗效。方法以80例慢性化脓性中耳炎静止期并陈旧性鼓膜大穿孔患者为研究对象,分为耳内镜下手术组(耳内镜组)40例,接受耳内镜下夹层法鼓膜成形术,显微镜下手术组(显微镜组)40例,于显微镜下行夹层法鼓膜成形术,比较两组的平均手术时间、鼓膜移植成功率、术耳术前与术后的气骨导差。结果耳内镜组中无一例行耳道切开扩大外耳道,显微镜组患者均采取耳道切口,其中6例实施外耳道成形术;显微镜组平均手术时间(93.3±17.6 min)长于耳内镜组(76.6±13.1 min)(P<0.05)。耳内镜组和显微镜组的鼓膜移植成功率分别为92.5%和95.0%,两组比较差异无统计学意义(P>0.05)。耳内镜组术耳气骨导差由术前19.1±7.6 dB降低为9.8±1.6 dB(P<0.05);显微镜组术耳气骨导差由18.1±7.8 dB降低为12.8±1.6 dB(P<0.05);两组听力均较术前明显改善,但两组间术后气骨导差的差异无统计学意义(P>0.05)。结论耳内镜下与传统显微镜下采用耳屏软骨-软骨膜夹层法修补鼓膜大穿孔效果差异无统计学意义,如果病例选择合适,耳内镜下手术时间短、不需行外耳道切口或行外耳道成形术。
关键词
显微镜;耳内镜;鼓膜穿孔;鼓室成形术
基金项目(Foundation):
作者
冀庆军;柴伟;黄辉;何苗;李大鹏;孙敬武;
参考文献

1 郭梦和,黄以乐,王锦玲.夹层鼓膜成形术治疗鼓膜穿孔53例报告[J].临床耳鼻咽喉科杂志,1999,13:147.

2 Patil BC,Misale PR,Mane RS.Outcome of interlay grafting in type 1 tympanoplasty for large central perforation[J].Indian J Otolaryngol Head Neck Surg,2014,66:418.

3 区永康,郑亿庆,陈穗俊,等.耳内镜在经耳道鼓膜修补术的应用[J].临床耳鼻咽喉科杂志,2003,17:237.

4 Preyer S.Endoscopic ear surgery a complement to microscopic ear surgery[J].HNO,2017,65(Suppl1):29.

5 Kozin ED,Gulati S,Kaplan AB,et al.Systematic review of outcomes following observational and operative endoscopic middle ear surgery[J].Laryngoscope,2015,125:1205.

6 Caroline CJ,Cameron S,Colin A,et al.The palisade cartilage tympanoplasty technique:a systematic review and meta-analysis[J].J Otolaryngol Head Neck Surg,2017,46:48.Published online.

7 Lakpathi G,Sudarshan Reddy L,And A.Comparative study of endoscope assisted myringoplasty and microscopic myringoplasty[J].Indian J Otolaryngol Head Neck Surg,2016,68:185.

8 Elliott Kozin D,Shawn G,Ashton L,et al.Systematic review of endoscopic middle ear surgery outcomes[J].Laryngoscope,2015,125:1205.

9 Kozin ED,Lehmann A,Carter M,et al.Thermal effects of endoscopy in a human temporal bone model:implications for endoscopic ear surgery[J].Laryngoscope,2014,124:E332.

10 Richard S,Jan H.Multiple cerebral venous thrombosis after endoscopic stapedotomy:a potential role of endoscope-produced heat[J].Acta Oto-Laryngologic Case Reports,2017,2:21.