耳内镜下耳屏软骨-软骨膜鼓膜修补术后的短期疗效观察

Short-term efficacy of endoscopic repair of tragal cartilage with perichondrium membrane

摘要:

目的 探讨耳内镜下耳屏软骨-软骨膜鼓膜修补术后的短期疗效。方法 回顾性分析2019年9月－2022年8月该院收治的78例鼓膜穿孔患者的临床资料，患者均采用耳内镜下鼓膜修补术。术后随访3个月，观察鼓膜形态和穿孔愈合情况，记录内镜图像、干耳时间、术前术后听力及耳鸣情况，以及外耳道狭窄等并发症的发生率。结果 术后3个月，鼓膜穿孔愈合率为97.44%（76/78），愈合良好，平均气导听阈较术前明显改善，气骨导间距较术前明显缩小，耳鸣较术前明显改善，差异均有统计学意义（P<0.05）。干耳时间为（4.21±1.12）周。术后出现肉芽5例，再穿孔2例，真菌感染2例，术腔感染、耳屏感染、外耳道狭窄和切口瘢痕各1例，所有患者术后均未发生面神经麻痹和感音神经性聋等严重并发症。结论 耳内镜下耳屏软骨-软骨膜鼓膜修补术是一种安全、有效的手术方法。根据术后愈合规律、内镜下鼓膜和外耳道形态特征，可为鼓膜修补术后正常中耳转归和并发症的诊疗，提供临床参考。

Abstract:

Objective To investigate the short-term effect of endoscopic repair of tragal cartilage with perichondrium membrane.Methods 78 patients with tympanic membrane perforation from Sept 2019 to Aug 2022 were retrospectively analyzed. The patients were treated with otoscopic tympanic membrane repair. Postoperative follow-up was performed for 3 months to observe the tympanic membrane morphology and healing of the perforation and to record the patients' endoscopic images, dry ear time, preoperative and postoperative hearing and tinnitus, and the incidence of complications, such as stenosis of the external auditory canal.Results The healing rate of tympanic membrane perforation was 97.44% (76/78) in 78 patients at 3 months postoperatively, with good postoperative healing, significant improvement in mean postoperative air-conducted hearing thresholds compared with the preoperative period, reduction in air-bone gap, and improvement in tinnitus after surgery compared with the preoperative period, the differences were statistically significant (P < 0.05). Duration of dry ear was (4.21 ± 1.12) weeks. The postoperative granulation in 5 cases, reperforation in 2 cases, fungal infection in 2 cases, infection of the operative cavity, infection of the ear screen, stenosis of the external auditory canal and scarring of the incision in 1 case each, and none of the patients suffered any serious postoperative complications such as facial nerve palsy and sensorineural deafness.Conclusion Otoscopic tympanic repair of tragal cartilage with perichondrium membrane is a safe and effective surgical method. The postoperative healing pattern and the morphological characteristics of the tympanic membrane and external auditory canal under endoscopy provide a clinical reference for the average middle ear regression and complications after tympanic membrane repair.