耳内镜下鼓室成形术临床效果观察  

Efficacy of otoendoscopic tympanoplasty

作　　者：陈晓红[1] 林发明 李海同[1] 骆云珍[1] CHEN Xiaohong;LIN Faming;LI Haitong(Department of Otolaryngology, the Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, China)

机构地区：[1]嘉兴学院附属第二医院(嘉兴市第二医院)耳鼻咽喉科,314000

出　　处：《浙江医学》2019年第5期445-448,I0001,共5页Zhejiang Medical Journal

摘　　要：目的观察耳内镜下鼓室成形术的临床效果。方法选取慢性化脓性中耳炎、中耳胆脂瘤、鼓室硬化症患者49例,均在耳内镜下行手术治疗,根据病变情况不同,分别行Ⅰ、Ⅱ、Ⅲ型鼓室成形术,必要时联合上鼓室、鼓窦切开及重建。患者术后随访,观察鼓膜愈合、听力恢复(比较术前、术后3个月听力平均纯音阈值与气骨导差)、味觉改变及并发症发生情况。结果 48例(97.96%)患者术后鼓膜一期完全愈合,所有患者术后3个月内鼓膜均完全愈合。行Ⅰ、Ⅱ、Ⅲ型鼓室成形术患者术后3个月听力平均纯音阈值与气骨导差均低于术前(均P<0.05),患者术后3个月听力较术前改善明显。术中因清理病变组织未能成功保留鼓索神经者13例(26.53%),其中9例患者术后有味觉部分缺失症状,术后3～6个月味觉逐渐恢复;解剖学成功保留鼓索神经者29例(59.18%),但有2例患者自觉术后味觉部分缺失,术后3个月味觉逐渐恢复。术后所有患者均未出现严重并发症。结论耳内镜下鼓室成形术术后鼓膜一期愈合率较高,听力改善效果明显,鼓索神经损伤率较低,并发症少,值得临床推广。Objective To assess the efficacy of otoendoscopic tympanoplasty. Methods Clinical data of 49 patients with chronic suppurative otitis, attic cholesteatoma or tympanosclerosis who received endoscopic tympanoplasty were retrospectively analyzed. TypeⅠ,Ⅱ and Ⅲ tympanoplasty were performed according to the different conditions;ossiculoplasty and attic reconstruction were also performed if necessarily. The graft success rate,audiometry improvement,changes in taste and other complications were also assessed postoperatively. The mean pure tone threshold and the air-bone gap were compared before and 3months after operation. Results The tympanic membrane of 48 patients (97.96%) was completely healed in the first stage after surgery, and the overall graft success rates was100% in 3 months after surgery. The mean pure tone threshold and the air-bone gap were lower than those before operation (P<0.05), and the hearing was improved significantly. Thirteen patients (26.53%) failed to retain the tympanal nerve due to intraoperative lesion cleaning, among whom9 cases had partial loss of taste after surgery, and then gradually recovered after 3-6 months. Twenty nine patients (59.18%) successfully retained tympanal nerve anatomically, however, 2 cases lost partial taste after surgery, which was recovered 3 months after. There were no complications such as severe sensoneural hearing loss, facial paralysis or vertigo. Conclusion The rate of primary healing of tympanic membrane after otoendoscopic tympanoplasty is higher with significant hearing improvement;the rates of tympanic cord nerve injury and postoperative complications are low, indicating that the otoendoscopic tympanoplasty is worthy of clinical promotion.

关 键 词：耳内镜 鼓室成形术 疗效 听力 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]