耳内镜下蝶形软骨鼓膜成形术日间手术的临床疗效分析

Clinical analysis of endoscopic inlay butterfly cartilage tympanoplasty in day surgery mode

摘要:

目的 探讨耳内镜下蝶形软骨鼓膜成形术（BCT）日间手术的临床疗效和安全性。方法 选取2021年6月－2022年6月于该院住院治疗的鼓膜穿孔患者120例，随机分为两组，观察组（60例）采用耳内镜下BCT，对照组（60例）采用耳内镜下耳屏软骨膜法修补鼓膜。两组患者均在门诊完成各项术前检查，且在24 h内完成入院、手术和出院各步骤。比较两组患者手术情况（手术时间和术中出血量）、术后6个月纯音听阈均值（PTA）、气骨导间距（A-B gap）、鼓膜愈合率和并发症情况。结果 两组患者手术时间和术中出血量比较，差异均无统计学意义（P > 0.05）；术后6个月，两组患者PTA和A-B gap较术前降低，差异均有统计学意义（P < 0.01），观察组PTA为（23.40±4.40）dB HL，A-B gap为（9.11±3.13）dB HL，明显低于对照组的（29.12±3.33）dB HL和（14.86±3.20）dB HL，差异均有统计学意义（P < 0.05）；两组患者术后鼓膜愈合率比较，差异无统计学意义（P > 0.05）；观察组并发症发生率为5.0%（3/60），明显低于对照组的21.7%（13/60），差异有统计学意义（P < 0.05）。结论 耳内镜下BCT治疗鼓膜穿孔安全、有效，较耳屏软骨膜修补术患者术后听力恢复好，且并发症少，更适合于日间手术模式。值得临床推广应用。

Abstract:

Objective To investigate the clinical effect and safety of endoscopic inlay butterfly cartilage tympanoplasty (BCT) by day surgery mode.Method 120 patients with tympanic membrane perforation from June 2021 to June 2022 were randomly divided into two groups, the observation group of 60 patients underwent endoscopic inlay BCT, the control group of 60 patients underwent endoscopic tympanic membrane repair with tragus cartilage membrane. Both groups of patients completed all preoperative examinations in the outpatient department and completed the steps of admission, surgery, and discharge within 24 h. The surgical conditions (operation time and intraoperative blood loss), pure tone average (PTA) after 6 months, air-bone gap (A-B gap) after 6 months, tympanic membrane healing rate, and complications were compared between the two groups.Results There was no statistical significance in the operation time and intraoperative blood loss between the observation group and the control group (P > 0.05). After 6 months, the PTA and A-B gap of both groups were lower than those before the surgery (P < 0.01), the observation group had a significantly lower PTA (23.40 ± 4.40) dB HL and A-B gap (9.11 ± 3.13) dB HL than the control group (29.12 ± 3.33) dB HL and (14.86 ± 3.20) dB HL, with statistically significant differences (P < 0.05). There was no statistical significance in the tympanic membrane healing rate between the two groups after surgery (P > 0.05), but the incidence of complications in the observation group was 5.0% (3/60), significantly lower than that in the control group (21.7%, 13/60), with a statistically significant difference (P < 0.05).Conclusion Endoscopic inlay BCT is safe and effective in the treatment of tympanic membrane perforation, with better hearing recovery than tragus cartilage membrane repair surgery, fewer complications, and more suitable for day surgery mode. It is worthy clinical application.