-
鼓膜穿孔的原因很多,慢性化脓性中耳炎是其常见病因之一[1],其次多为外伤性或医源性。传统的手术治疗方式多为显微镜下耳后入路行单纯鼓膜修补或乳突鼓室手术,修补材料为颞肌筋膜、脂肪组织、乳突骨膜等[2-3],多为就近取材。近年来随着耳内镜的发展,依据其广角和多角度的优点,在内镜下经外耳道的自然通道入路,可以清晰地显示鼓室内的各个解剖部位及病变情况,并能很好地清除病变。在耳内镜下的鼓室成形中所用的修补材料就近多为耳屏软骨(包含或不包含软骨膜),然而鼓膜穿孔的大小和类型是多样的,适合的耳屏软骨-软骨膜制作对于穿孔的愈合及术后听力的影响尤为重要。为此,我们选择在耳内镜下完成鼓室探查+不同类型的鼓室成形术的病人,回顾性分析不同类型的耳屏软骨-软骨膜修补鼓膜穿孔情况。现作报道。
-
所有病人随访6~12个月,对照组鼓膜愈合24例(80.0%), 大穿孔变小穿孔6例(20.0%)。观察组鼓膜愈合30例(100%),5例出现感染情况,外耳道见脓性分泌物,经抗感染及对症处理后,1个月后逐渐干耳;1例病人出现耳屏处青紫,可能是外耳道口压迫不紧所致,1周后青紫慢慢消退无感染征象。2组鼓膜愈合率差异有统计学意义(Fisher′s确切概率法,P < 0.05)。所有病人未出现感音神经性聋、周围性面瘫等严重并发症。术中及术后鼓膜图情况见图 2。
-
术前及术后通过纯音测听结果比较听力情况。2组术前气导听阈、气骨导差值差异均无统计学意义(P>0.05),术后6个月观察组气导听阈、气骨导差值均明显优于对照组(P < 0.01), 且组内比较结果显示,术后6个月2组气导听阈、气骨导差值均明显优于术前(P < 0.01)(见表 1)。
分组 n 气导听阈/dB 气骨导差/dB 术前 对照组 30 45.6±8.6 21.4±4.8 观察组 30 43.2±5.2 20.1±3.6 t — 1.31 1.19 P — >0.05 >0.05 术后6个月 对照组 30 34.9±7.8** 12.1±1.9** 观察组 30 28.9±3.1** 9.3±2.1** t — 3.92 5.42 P — < 0.01 < 0.01 组内配对t检验:**P < 0.01 表 1 2组病人手术前后纯音测听结果比较(x±s)
耳内镜下不同类型耳屏软骨-软骨膜修补鼓膜穿孔临床疗效分析
Clinical effect analysis of repairing tympanic membrane perforation with different types of tragus cartilage-perichondrium under otoendoscope
-
摘要:
目的探讨耳内镜下不同类型的耳屏软骨-软骨膜修补鼓膜穿孔的临床疗效。 方法选取60例(60耳)实施耳内镜手术的病人,随机分为对照组和观察组各30例,其中对照组采用全厚岛状耳屏软骨-软骨膜修补鼓膜穿孔;观察组采用半厚岛状耳屏软骨-软骨膜复合体修补鼓膜穿孔。所有病人随访6~12个月,对比分析2组鼓膜穿孔的鼓膜愈合情况及听力改善情况。 结果观察组鼓膜愈合率100.0%(30/30),高于对照组80.0%(24/30)(P < 0.05)。2组术前气导听阈、气骨导差值差异均无统计学意义(P>0.05),术后观察组气导听阈、气骨导差值均明显优于对照组(P < 0.01), 且组内比较结果显示,术后2组气导听阈、气骨导差值均明显优于术前(P < 0.01)。 结论耳内镜下耳屏软骨-软骨膜修补穿孔的鼓膜是可行的,尤其半厚岛状耳屏软骨-软骨膜复合体成活率高,可修补不同大小的鼓膜穿孔,且益于提高听力,术后听力改善效果良好。 Abstract:ObjectiveTo investigate the clinical efficacy of repairing tympanic membrane perforation with different types of tragus cartilage-perichondrium under otoendoscope. MethodsSixty patients (60 ears) who underwent endoscopic surgery were randomly divided into the control group (n=30) and the observation group (n=30).In the observation group, the perforation of tympanic membrane was repaired by semi-thick island of tragus cartilage-perichondrium complex.All patients were followed up for 6-12 months.The healing of tympanic membrane and hearing improvement were compared between the two groups. ResultsThe healing rate of tympanic membrane in the observation group was 100.0% (30/30), which was higher than 80.0%(24/30) in the control group (P < 0.05).There was no significant difference in the air-conductance threshold and air-bone conductance difference between the two groups before operation (P>0.05).The air-conductance threshold and air-bone conductance difference of the observation group were significantly better than those of the control group (P < 0.01), and the intra-group comparison showed that the air-conductance threshold and air-bone conductance difference of the two groups after operation were significantly better than those before operation (P < 0.01). ConclusionsIt is feasible to repair the perforated tympanic membrane under otoendoscope, especially the semi-thick island of auricular cartilage-perichondrium complex, which has a high survival rate, can repair the perforation of tympanic membrane of different sizes, and is beneficial to improve hearing, and the postoperative hearing improvement effect is good. -
Key words:
- tympanic membrane perforation /
- otoendoscope /
- tragus and perichondrium /
- tympanoplasty
-
表 1 2组病人手术前后纯音测听结果比较(x±s)
分组 n 气导听阈/dB 气骨导差/dB 术前 对照组 30 45.6±8.6 21.4±4.8 观察组 30 43.2±5.2 20.1±3.6 t — 1.31 1.19 P — >0.05 >0.05 术后6个月 对照组 30 34.9±7.8** 12.1±1.9** 观察组 30 28.9±3.1** 9.3±2.1** t — 3.92 5.42 P — < 0.01 < 0.01 组内配对t检验:**P < 0.01 -
[1] 张金平, 谢记发, 罗许勇. 耳内镜下耳屏软骨-软骨膜鼓膜成形术的手术技巧及疗效分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2020, 28(6): 401. [2] 姜妍, 李江平, 王鹏举. 耳内镜下鼓室成形术鼓膜穿孔修复材料的比较[J]. 听力学及言语疾病杂志, 2019, 27(6): 623. [3] MOHANTY S, MANIMARAN V, UMAMAHESWARAN P, et al. Endoscopic cartilage versus temporalis fascia grafting for anterior quadrant tympanic perforations—a prospective study in a tertiary care hospital[J]. Auris Nasus Larynx, 2018, 45(5): 936. doi: 10.1016/j.anl.2018.01.002 [4] 张静, 李希平. 耳内镜下鼓室成形术临床疗效分析[J]. 解放军医学院学报2019, 40(5): 441. [5] 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(2): 5. [6] 潘晓丹, 赵守琴, 赵燕玲, 等. 耳内镜下内衬法与夹层法鼓膜修补术的疗效观察[J]. 中国耳鼻咽喉颅底外科杂志, 2022, 28(1): 69. [7] 熊辉强, 魏小林. 耳内镜下耳屏软骨-软骨膜在湿耳鼓室成形术中的疗效观察[J]. 江西医药, 2021, 56(1): 87. [8] JALALI MM, MOTASADDI M, KOUHI A, et al. Comparison of cartilage with temporalis fascia tympanoplasty: a meta-analysis of comparative studies[J]. Laryngo Scope, 2017, 127(9): 2139. [9] 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. [10] NEUMANN A, HENNIG A, SCHULTZ-COULON HJ. Morphological and functional results of palisade cartilage tympanoplasty[J]. HNO, 2002, 50 (10): 935. [11] 谭志强, 刘映辰, 刘斌, 等. 耳内镜下软骨岛技术结合栅栏软骨技术修补鼓膜次全穿孔的临床研究[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(11): 1009. [12] 张文伟, 刘稳, 刘后广, 等不同材料修补不同面积中央性鼓膜穿孔的有限元模型分析[J]. 听力学及言语疾病杂志, 2022, 30(1) : 58.