耳内镜下鼓室成形术临床疗效分析
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摘要
目的探讨耳内镜下鼓室成形术的临床疗效。方法选取2016年1月-2018年3月就诊于我科并行耳内镜下鼓室成形术的91例患者(91耳),男39例、女52例,年龄19～79(42.7±15.7)岁,分析耳内镜手术方法、鼓膜愈合及听力改善情况。结果 91耳中单纯慢性化脓性中耳炎74耳,慢性化脓性中耳炎合并鼓室硬化17耳;其中行鼓室成形术Ⅰ型82例,鼓室成形术Ⅱ型9例。术后2周取出耳道内填塞材料,以后每隔3个月门诊复诊;87耳穿孔鼓膜完全愈合并无再次穿孔、内陷;4耳遗留小穿孔,均于二次局麻下手术处理后完全愈合。术前及术后6个月纯音测听结果比较(其中1耳术前、术后纯音测听均提示全聋,不做统计):90耳术前气导听阈为(46.3±16.0) dB HL,术后气导听阈为(29.0±12.4) dB HL(P <0.01);术前气骨导差为(22.8±9.1) dB HL,术后气骨导差为(7.8±3.6) dB HL(P <0.01)。纳入统计的慢性化脓性中耳炎伴鼓室硬化16耳术前气导听阈为(50.7±19.2) dB HL,术后气导听阈为(26.6±3.4) dB HL(P <0.01);术前气骨导差为(31.3±10.4) dB HL,术后气骨导差为(8.0±3.4) dB HL(P <0.01)。结论耳内镜下鼓室成形术视野清晰、手术创伤小、安全有效,可取得良好的听力改善效果,值得临床推广。
Objective To investigate the clinical outcomes of otoendoscopic tympanoplasty. Methods A retrospective analysis was carried out in clinical data about 91 patients(91 ears, 39 males and 52 females, aged 19-79 years, average age of 42.7±15.7 years)who received otoendoscopic tympanoplasty in our department from January 2016 to March 2018. The operative method, tympanic membrane healing and hearing improvement were analyzed. Results Of the 91 cases, 74 had chronic suppurative otitis media, 17 had chronic suppurative otitis media complicated with tympanosclerosis; Tympanoplasty type I was performed in 82 cases and tympanoplasty type II in 9 cases. The ear canal filling materials were taken out 2 weeks after operation, and the follow-up visits were conducted every 3 months. Membranes of 87 ears healed completely without perforation or invagination. Membranes in 4 cases still had small perforations and completely healed after operation under local anesthesia. The pre-and postoperative pure tone audiometry results were compared(one ear was excluded because of total deafness before and after operation). The preoperative air conduction hearing threshold of 90 ears was 46.3±16.0 dB HL, and the postoperative air conduction hearing threshold was 29.0±12.4 dB HL(P <0.01). The preoperative air-bone gap was 22.8±9.1 dB HL in 90 ears, and it was 7.8±3.6 dB HL after operation(P <0.01). In16 ears with chronic suppurative otitis media complicated with tympanosclerosis, the preoperative air conduction hearing threshold was 50.7±19.2 dB HL, and it was 26.6±3.4 dB HL postoperatively(P <0.01); The preoperative air-bone gap was 31.3±10.4 dB HL, and the postoperative one was 8.0±3.4 dB HL(P <0.01). Conclusion Otoendoscopic tympanoplasty is a safe and effective technique with clear visualization and minimal invasion, which is worthy of clinical application.
Objective To investigate the clinical outcomes of otoendoscopic tympanoplasty. Methods A retrospective analysis was carried out in clinical data about 91 patients(91 ears, 39 males and 52 females, aged 19-79 years, average age of 42.7±15.7 years)who received otoendoscopic tympanoplasty in our department from January 2016 to March 2018. The operative method, tympanic membrane healing and hearing improvement were analyzed. Results Of the 91 cases, 74 had chronic suppurative otitis media, 17 had chronic suppurative otitis media complicated with tympanosclerosis; Tympanoplasty type I was performed in 82 cases and tympanoplasty type II in 9 cases. The ear canal filling materials were taken out 2 weeks after operation, and the follow-up visits were conducted every 3 months. Membranes of 87 ears healed completely without perforation or invagination. Membranes in 4 cases still had small perforations and completely healed after operation under local anesthesia. The pre-and postoperative pure tone audiometry results were compared(one ear was excluded because of total deafness before and after operation). The preoperative air conduction hearing threshold of 90 ears was 46.3±16.0 dB HL, and the postoperative air conduction hearing threshold was 29.0±12.4 dB HL(P <0.01). The preoperative air-bone gap was 22.8±9.1 dB HL in 90 ears, and it was 7.8±3.6 dB HL after operation(P <0.01). In16 ears with chronic suppurative otitis media complicated with tympanosclerosis, the preoperative air conduction hearing threshold was 50.7±19.2 dB HL, and it was 26.6±3.4 dB HL postoperatively(P <0.01); The preoperative air-bone gap was 31.3±10.4 dB HL, and the postoperative one was 8.0±3.4 dB HL(P <0.01). Conclusion Otoendoscopic tympanoplasty is a safe and effective technique with clear visualization and minimal invasion, which is worthy of clinical application.
引文
1中华医学会耳鼻咽喉头颈外科学分会耳科学组,中华耳鼻咽喉头颈外科杂志编辑委员会耳科组.中耳炎临床分类和手术分型指南(2012)[J].中华耳鼻咽喉头颈外科杂志,2013,48(1):5.
2赵宇,郑永波,娄麟,等.耳内镜和显微镜下镫骨手术的比较[J].中华耳科学杂志,2017,15(4):408-411.
3梁伟英,关亚峰,陆钊群,等.耳内镜下自体听骨链重建术的应用[J].中华耳科学杂志,2018,16(2):181-186.
4张绍兴,马芙蓉,潘滔,等.鼓室硬化的外科手术治疗及疗效分析[J].临床耳鼻咽喉头颈外科杂志,2015,29(14):1238-1242.
5杨琼.耳内镜下中耳手术[J].临床耳鼻咽喉头颈外科杂志,2018,32(5):393-396.
6马晓波,赵守琴,夏寅,等.耳内镜下中耳结构观察[J].中国耳鼻咽喉头颈外科,2008,15(4):183-185.
7杨海弟,高敏倩,熊浩,等.耳内镜下中耳手术及鼓室成形术效果分析[J].中华耳科学杂志,2017,15(4):403-407.
8张瑾,王冰,杨启梅,等.全耳内镜下经外耳道上鼓室胆脂瘤手术分析[J].中华耳科学杂志,2017,15(4):420-425.
9侯昭晖,李瑞香,杨仕明.耳内镜技术在中耳胆脂瘤手术中的应用策略[J].中华耳科学杂志,2017,15(4):393-397.
10杨琼,张全明,曾楠,等.耳内镜下经耳道入路治疗局限性上鼓室胆脂瘤[J].中华耳科学杂志,2017,15(4):416-419.
11 Lubianca-Neto JF.Inlay butterfly cartilage tympanoplasty(Eavey technique)modified for adults[J].Otolaryngol Head Neck Surg,2000,123(4):492-494.
12 Awad OG,Hamid KA.Endoscopic type 1 tympanoplasty in pediatric patients using tragal cartilage[J].JAMA Otolaryngol Head Neck Surg,2015,141(6):532-538.
13李鹏,张奕,符秋养,等.耳内镜下耳屏软骨-软骨膜修补鼓膜大穿孔的临床观察[J].临床耳鼻咽喉头颈外科杂志,2014,28(22):1762-1764.
14杨启梅,张文,韩想利,等.耳内镜下耳屏软骨-软骨膜治疗鼓膜穿孔的临床研究[J].中华耳科学杂志,2016,14(6):778-782.
15 Gerber MJ,Mason JC,Lambert PR.Hearing results after primary cartilage tympanoplasty[J].Laryngoscope,2000,110(12):1994-1999.
16 Lou ZC.The indication for endoscopic butterfly cartilage myringoplasty in children[J].Auris Nasus Larynx,2017,44(4):498-499.
17 Haksever M,Akduman D,Solmaz F,et al.Inlay butterfly cartilage tympanoplasty in the treatment of dry central perforated chronic otitis media as an effective and time-saving procedure[J].Eur Arch Otorhinolaryngol,2015,272(4):867-872.
18张珂,马芙蓉,宋为明,等.鼓室硬化患者手术前后骨导听力变化的临床研究[J].临床耳鼻咽喉头颈外科杂志,2017,31(16):1228-1230.
2赵宇,郑永波,娄麟,等.耳内镜和显微镜下镫骨手术的比较[J].中华耳科学杂志,2017,15(4):408-411.
3梁伟英,关亚峰,陆钊群,等.耳内镜下自体听骨链重建术的应用[J].中华耳科学杂志,2018,16(2):181-186.
4张绍兴,马芙蓉,潘滔,等.鼓室硬化的外科手术治疗及疗效分析[J].临床耳鼻咽喉头颈外科杂志,2015,29(14):1238-1242.
5杨琼.耳内镜下中耳手术[J].临床耳鼻咽喉头颈外科杂志,2018,32(5):393-396.
6马晓波,赵守琴,夏寅,等.耳内镜下中耳结构观察[J].中国耳鼻咽喉头颈外科,2008,15(4):183-185.
7杨海弟,高敏倩,熊浩,等.耳内镜下中耳手术及鼓室成形术效果分析[J].中华耳科学杂志,2017,15(4):403-407.
8张瑾,王冰,杨启梅,等.全耳内镜下经外耳道上鼓室胆脂瘤手术分析[J].中华耳科学杂志,2017,15(4):420-425.
9侯昭晖,李瑞香,杨仕明.耳内镜技术在中耳胆脂瘤手术中的应用策略[J].中华耳科学杂志,2017,15(4):393-397.
10杨琼,张全明,曾楠,等.耳内镜下经耳道入路治疗局限性上鼓室胆脂瘤[J].中华耳科学杂志,2017,15(4):416-419.
11 Lubianca-Neto JF.Inlay butterfly cartilage tympanoplasty(Eavey technique)modified for adults[J].Otolaryngol Head Neck Surg,2000,123(4):492-494.
12 Awad OG,Hamid KA.Endoscopic type 1 tympanoplasty in pediatric patients using tragal cartilage[J].JAMA Otolaryngol Head Neck Surg,2015,141(6):532-538.
13李鹏,张奕,符秋养,等.耳内镜下耳屏软骨-软骨膜修补鼓膜大穿孔的临床观察[J].临床耳鼻咽喉头颈外科杂志,2014,28(22):1762-1764.
14杨启梅,张文,韩想利,等.耳内镜下耳屏软骨-软骨膜治疗鼓膜穿孔的临床研究[J].中华耳科学杂志,2016,14(6):778-782.
15 Gerber MJ,Mason JC,Lambert PR.Hearing results after primary cartilage tympanoplasty[J].Laryngoscope,2000,110(12):1994-1999.
16 Lou ZC.The indication for endoscopic butterfly cartilage myringoplasty in children[J].Auris Nasus Larynx,2017,44(4):498-499.
17 Haksever M,Akduman D,Solmaz F,et al.Inlay butterfly cartilage tympanoplasty in the treatment of dry central perforated chronic otitis media as an effective and time-saving procedure[J].Eur Arch Otorhinolaryngol,2015,272(4):867-872.
18张珂,马芙蓉,宋为明,等.鼓室硬化患者手术前后骨导听力变化的临床研究[J].临床耳鼻咽喉头颈外科杂志,2017,31(16):1228-1230.