全耳内镜下耳屏软骨膜-薄软骨复合体在Ⅰ型鼓室成形术中的应用效果分析

Effect analysis of the tragus perichondrium-thin cartilage complex under total auricular endoscopy in tympanoplasty type Ⅰ

摘要:

目的 探讨耳屏软骨膜-薄软骨复合体在全耳内镜下Ⅰ型鼓室成形术中的应用价值。方法 选取2019年1月－2020年12月该院70例（70耳）行Ⅰ型鼓室成形术的慢性中耳炎患者作为研究对象，根据随机化原则分为两组，对照组35例使用耳屏软骨膜，观察组35例使用耳屏软骨膜-薄软骨复合体。比较两组患者术后鼓膜愈合情况及听力变化。结果 对照组中鼓膜愈合30例（85.7%），再穿孔5例（14.3%）；观察组中鼓膜愈合35例（100.0%），未出现穿孔（0.0%），移植物无移位及内陷；两组患者穿孔愈合率比较，差异有统计学意义（χ² = 5.39，P = 0.020）。对照组平均气导听阈由术前（36.04±2.51）dB HL下降至术后（22.71±1.44）dB HL，平均气骨导差由术前（21.14±2.78）dB HL缩小至术后（9.93±2.05）dB HL；观察组平均气导听阈由术前（36.29±2.26）dB HL下降至术后（22.03±1.89）dB HL；平均气骨导差由术前（21.07±2.52）dB HL缩小至术后（9.67±1.94）dB HL，两组患者组内手术前与术后6个月平均气导听阈与气骨导差比较，差异均有统计学意义（P < 0.05）；两组患者术后平均气导听阈及气骨导差比较，差异均无统计学意义（P > 0.05）。结论 全耳内镜下应用耳屏软骨膜-薄软骨复合体行Ⅰ型鼓室成形术，鼓膜愈合率高，术后听力改善明显，其是一种有效且可靠的鼓膜修补材料，值得临床推广应用。

Abstract:

Objective To investigate the value of tragus perichondrium thin cartilage complex in type Ⅰ tympanoplasty under whole ear endoscope.Method 70 patients (70 ears) with chronic otitis media who underwent type Ⅰ tympanoplasty from January 2019 to December 2020 were selected as the research objects. They were divided into two groups according to the principle of randomization, 35 cases in the control group were treated with tragus perichondrium, 35 cases in the observation group were treated with tragus perichondrium thin cartilage complex. The healing of tympanic membrane and hearing changes were compared between the two groups.Result In the control group, 30 cases (85.7%) of tympanic membrane healed and 5 cases (14.3%) of re-perforation. In the observation group, 35 cases (100.0%) of tympanic membrane healed, there was no perforation (0.0%), and the graft had no displacement and invagination. There was significant difference in perforation healing rate between the two groups (χ² = 5.39, P = 0.020). In the control group, the average air conduction hearing threshold decreased from (36.04 ± 2.51) dB HL before operation to (22.71 ± 1.44) dB HL after operation. The mean air bone conductance decreased from (21.14 ± 2.78) dB HL before operation to (9.93 ± 2.05) dB HL after operation. In the observation group, the average air conduction hearing threshold decreased from (36.29 ± 2.26) dB HL before operation to (22.03 ± 1.89) dB HL after operation. The mean air bone conductance decreased from (21.07 ± 2.52) dB HL before operation to (9.67 ± 1.94) dB HL after operation. The average air conduction hearing threshold and air bone conduction difference before and 6 months after operation in the two groups were statistically significant (P < 0.05). There was no significant difference between the two groups (P > 0.05).Conclusion Type Ⅰ tympanoplasty of tragus perichondrium thin cartilage complex under whole ear endoscope has high tympanoplasty healing rate and significant postoperative hearing improvement. It is an effective and reliable tympanoplasty material, which is worthy of clinical application.