耳内镜蝶形软骨嵌入法修补鼓膜前缘穿孔的临床研究  

Clinical study of butterfly cartilage myringoplasty for anterior quadrant tympanic perforation under endoscope

作　　者：李阳[1] 刘海琴[1] 盛颖 闫静[1] 许映龙[1] 梁建民[1] 吴宝俊[1] 张青[1] 任晓勇[1] Li Yang;Liu Haiqin;Sheng Ying;Yan Jing;Xu Yinglong;Liang Jianmin;Wu Baojun;Zhang Qing;Ren Xiaoyong(Department of Otolaryngology Head and Neck Surgery,the Second Affiliated Hospital,Xi′an Jiaotong University,Xi′an 710004,China)

机构地区：[1]西安交通大学第二附属医院耳鼻咽喉头颈外科病院,西安710004

出　　处：《中华耳鼻咽喉头颈外科杂志》2020年第6期611-614,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：陕西省国际科技合作与交流计划(2020KW-045);西安市科技计划项目(2017119SF/YX013(4))。

摘　　要：目的探讨耳内镜下蝶形软骨嵌入法修补鼓膜前缘穿孔的临床疗效。方法回顾性分析2016年4月至2018年10月西安交通大学第二附属医院接受耳内镜下蝶形软骨嵌入法修补鼓膜前方穿孔的患者共38例。其中男性16例,女性22例,平均年龄(34.5±14.2)岁。分析穿孔愈合率及术后并发症,采用SPSS 23.0统计软件比较手术前后的气导听阈及气骨导差。结果术后平均随访(9.4±3.1)个月(6~18个月),穿孔愈合率94.7%(36/38)。术后气导平均听阈为(21.4±7.7)dB HL,明显小于术前气导平均听阈[(30.9±8.9)dB HL],差异有统计学意义(t=5.353,P<0.05);术后平均骨气导差为(10.8±6.0)dB,明显小于术前平均骨气导差[(18.4±6.3)dB],差异有统计学意义(t=4.162,P<0.05)。骨气导差缩小(8.3±1.5)dB。随访期间,发生鼓膜炎2例(4.7%,2/38),再穿孔2例(4.7%,2/38),钝角愈合1例(2.4%,1/38)。无继发性胆脂瘤发生。结论耳内镜下蝶形软骨嵌入法修补鼓膜前方穿孔简单、微创,成功率高、并发症少,值得临床推广。Objective To evaluate the results of butterfly cartilage myringoplasty for anterior quadrant tympanic perforation under endoscope.Methods Thirty-eight patients with anterior quadrant tympanic perforations who were subjected to endoscopic butterfly cartilage myringoplasty from April 2016 to October 2018 were included in this study, including 16 males and 22 females, with an average age of (34.5±14.2) years. The patients were reviewed retrospectively, and the pre-and post-operative pure tone audiometry (PTA) thresholds, pre-and post-operative air-bone gaps (ABG), post-operative graft success rates and complications were evaluated. SPSS 23.0 was used to analyze data.Results Mean post-operative follow-up duration was (9.4±3.1) months (range 6-18 months). The graft survival rate was 94.7% (36/38) . The preoperative and postoperative mean PTA was (30.9±8.9) dB HL and (21.4±7.7) dB HL respectively. Preoperative and postoperative mean ABG was (18.4±6.3) dB and (10.8±6.0) dB respectively. There was significant difference between pre-and postoperative PTA and ABG (t=5.353 and 4.162, P<0.05 for both). A postoperative ABG reduction of (8.3±1.5) dB was reached. Two (4.7%) patients had postoperative myringitis, two (4.7%) had recurrent perforation, and one (2.4%) had lateral healing of transplanted tympanic membrane in the postoperative follow-ups. No intratympanic cholesteatoma was observed.Conclusions Endoscopic butterfly inlay myringoplasty is a reliable, minimally invasive alternative method to repair anterior tympanic membrane perforations, with high closure rate and low risk of complications.

关 键 词：鼓膜穿孔 耳内镜 鼓膜成形术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]