耳内镜下经耳道鼓室成形手术的可行性分析

Analysis of exclusive endoscopic transcanal tympanoplasty

摘要:

探讨全耳内镜下经耳道鼓室成形手术疗效及可行性。方法?回顾性分析2016年2月－2017年10月收治的100例慢性化脓性中耳炎和鼓室胆脂瘤患者，同期行经耳道全耳内镜鼓室探查、鼓室病灶清除加鼓室成形手术，观察术后鼓膜形态恢复情况及愈合率，并比较手术前与手术后3个月平均气导听阈（PTA）及气骨导差（A～B gap）的差异。结果?100例患者术后鼓膜一期完全愈合96例（96%），遗留小穿孔4例（4%），均在门诊耳内镜下处理后完全愈合，内镜下见鼓膜形态良好。术前平均气导听阈为（43.45± 9.56）dB/HL，术后平均气导听阈为（27.23±6.89）dB/HL，术前术后比较，差异有统计学意义（P <0.01）。术前平均气骨导差为（28.42±6.78）dB/HL，术后平均气骨导差为（13.62±8.67）dB/HL，术前术后比较，差异有统计学意义（P <0.01）。结论?全耳内镜下经耳道探查处理中耳病灶的同时，行鼓室成形是一种安全有效的手术方法，耳内镜具有视野广及清晰、创伤小、恢复快及听力效果良好和并发症少等优点，具有良好的可行性，是未来中耳手术的一个热点及方向。

Abstract:

To explore the methods, effectiveness and feasibility of exclusive endoscopic transcanal tympanoplasty. Methods From February 2016 to Octobert 2017, 100 patients affected by chronic suppurative otitis media or cholesteatoma were underwent exclusive endoscopic transcanal tympanoplasty. With the retrospective study method, postoperative graft success and hearing outcomes (Pure tone audiometry, mean air-bone gap) were evaluated. Result 3 months after surgery, graft success rates were 96%, reperforations were seen in 4 patients and the perforated eardrums were successfully repaired by endoscopic in outpatient department. The mean preoperative pure tone was found (43.45 ± 9.56) dB/HL and the mean postoperative pure tone was found (27.23 ± 6.89) dB/HL (P < 0.01). The mean preoperative air bone gap was found (28.42 ± 6.78) dB/HL and the mean postoperative air bone gap was found (13.62 ± 8.67) dB/HL (P < 0.01). Conclusion Endoscopic transcanal tympanoplasty can be easily applied, it is a minimally invasive and safe method and can be given successful results with wide and clear vision.