持续灌流模式耳内镜下Ⅰ型鼓室成形术  

A Novel Continuous Irrigating Endoscopic Ear Surgery Mode for TypeⅠ Tympanoplasty

作　　者：廖华[1] 杨希林[1] 汪雷[1] 王文静[1] 任杰[1] 蒋梦炎 Liao Hua;Yang Xilin;Wang Lei;Wang Wenjing;Ren Jie;Jiang Mengyan(Department of Otolaryngology Head and Neck Surgery,Renmin Hospital of Wuhan University,Wuhan,430060,China)

机构地区：[1]武汉大学人民医院耳鼻咽喉头颈外科

出　　处：《听力学及言语疾病杂志》2019年第6期615-618,共4页Journal of Audiology and Speech Pathology

摘　　要：目的介绍一种持续灌流模式耳内镜下Ⅰ型鼓室成形术,探讨其技术特点及临床效果。方法将56例拟行Ⅰ型鼓室成形术的慢性化脓性中耳炎成人患者按不同耳内镜下手术操作模式分为持续灌流模式组(灌流模式组)和常规操作模式组(常规模式组),灌流模式组19例,其中大穿孔11例,中等穿孔8例;常规模式组37例,大、中、小穿孔例数分别为13、19、5例。两组均于内镜下采用夹层法以耳屏软骨-软骨膜复合移植物完成Ⅰ型鼓室成形术,灌流模式t组从耳道切口开始直至将软骨-软骨膜复合移植物放置完成全程在高速流水下完成,而常规模式组除术中不采用持续灌注模式外,其他步骤同灌流模式组。术后随访3~6个月。对两组患者的手术时间、术中拭镜次数、术后效果进行比较分析。结果灌流模式组和常规模式组平均手术时间分别为42.8±5.3 min和70.6±12.5 min,差异有统计学意义(P<0.0001);灌流模式组术中平均拭镜次数为6.7±1.6次,常规模式组为42.6±11.8次,差异有统计学意义(P<0.0001);常规模式组1例患者术后出现鼓膜后上方裂隙,经局部换药处理后愈合,手术成功率为97.3%,灌流模式组所有患者均一期修复成功,手术成功率为100%,差异无统计学意义(P>0.05)。两组患者术后3个月0.5~4 kHz气导平均听阈分别为22.2±6.3和23.3±8.3 dB HL,较术前(34.8±7.3和35.7±9.5 dB HL)均有显著改善(P<0.0001);两组之间差异无统计学意义(P>0.05)。结论持续灌流模式耳内镜下手术创新性地解决了耳内镜术中因出血镜头起雾对视野的不利影响,极大克服了耳内镜手术中需反复拭镜的弊端,利于连续操作,并部分解决单手操作的不足,明显缩短手术时间,改善手术操作体验。Objective To introduce a novel continuous irrigating mode for endoscopic ear surgery.The type I tympanoplasty was chosen as a model to illustrate the characteristics and clinical effects of the new technique.Methods A total of 56 patients who received endoscopic typeⅠtympanoplasty in our department were divided into two groups according to the continuous irrigating mode and traditional operation mode.There were 19 cases for the continuous irrigating mode group with 11 cases for large membrane perforation and 8 cases for medium membrane perforation.There were 37 cases for the traditional operation mode group with 13,19,and 5 cases for large,medium and small membrane perforation,respectively.All patients were operated by the same surgeon,and the sandwich technique was adopted under endoscope with the repair materials consisting of tragus cartilage-perichondrium composite grafts.The postoperative follow-up ranged from 3 to 6 months.For the irrigating endoscopic ear surgery mode,the whole operation was conducted completely under irrigating from making a incision of the external ear canal to the placement of the tragus cartilage-perichondrium composite grafts.While the traditional operation mode was operated without irrigating and the other steps were completely the same.The operation time,the number of scrubbing the lens and the postoperative effects of the two groups were compared.Results The mean operation time of the irrigating operation group and the traditional group was 42.8±5.3 minutes and 70.6±12.5 minutes respectively,there was statistical difference between the two groups(P<0.0001).The mean number of scrubbing the lens for the irrigating operation group was 6.7±1.6 and 42.6±11.8 for the traditional group,there was statistical difference between the two groups(P<0.0001).One patient in the traditional operation group had a postoperative posterior upper fissure and healed after local dressing treatment with the healing rate of 97.3%and all patients in the irrigating operation group successfully healed in

关 键 词：耳内镜外科 操作模式 持续灌流 鼓室成形术 

分 类 号：R746.9[医药卫生—神经病学与精神病学]