持续灌流模式耳内镜下Ⅲ、Ⅳ型鼓室硬化症手术疗效分析  

An Analysis of Short-term Outcomes of Endoscopic One-stage Tympanoplasty with Continuous Irrigation for Type Ⅲ and Ⅳ Tympanosclerosis

作　　者：廖华[1] 杨希林[1] 汪雷[1] 王文静[1] 任杰[1] 张志坚[1] LIAO Hua;YANG Xilin;WANG Lei;WANG Wenjing;REN Jie;ZHANG Zhijian(Center of Otorhinolaryngology Head and Neck Surgery,Renmin Hospital of Wuhan University)

机构地区：[1]武汉大学人民医院耳鼻咽喉头颈外科中心

出　　处：《中华耳科学杂志》2021年第2期218-222,共5页Chinese Journal of Otology

摘　　要：目的探讨采用持续灌流耳内镜手术模式(CIM-EES)一期鼓室成形术治疗Ⅲ、Ⅳ型鼓室硬化症的临床疗效。方法2019.3-2020.9对17例(21耳)Ⅲ、Ⅳ型鼓室硬化症患者,在持续灌流模式耳内镜下采用外嵌法,一期行Ⅱ型鼓室成形术,观察分析手术时间,鼓膜愈合成功率,并比较术前及术后6个月平均气、骨导听阈(PTA)及气骨导差(A-B gap)。结果17例患者(21耳)术后鼓膜均一期完全愈合。手术时间平均为60.6±7.0min,术前平均气导听阈54.70±10.38 dB HL,术后6个月平均气导听阈35.24±11.66 dB HL,差异具有统计学意义(P<0.001)。术前及术后6个月平均气骨导差分别为34.93±9.30 dBHL和15.65±7.07 dB,差异具有统计学意义(P<0.001)。术前、术后骨导平均听阈差异无统计学意义(P>0.05),术后无患者出现皮瓣缺血坏死及外耳道狭窄。未出现感音神经性耳聋、面瘫及眩晕并发症。结论CIM-EES可以针对性解决传统耳内镜手术出血起雾污染镜头、热损伤等缺陷,提高手术流畅性及安全性。尤其对于Ⅲ、Ⅳ型鼓室硬化症手术,在持续灌流模式下可以抵近观察并精细清理镫骨周围硬化灶,有助于一期完成听骨链重建。近期疗效满意,远期疗效尚有待进一步随访观察。相对于内植法和外植法,外嵌法是一种新的技术改良,可以最大程度维持鼓室腔容积,减少粘连及听骨链移位的发生。Objective To report outcomes of on one-stage endoscopic tympanoplasty with continuous irrigation for type Ⅲ and Ⅳ tympanosclerosis.Methods Seventeen patients(21 ears)with type Ⅲ or Ⅳ tympanosclerosis treated from March 2019 to September 2020 were included in the retrospective analysis.Endoscopy with continuous irrigation was used with the over-inlay technique to accomplish one-stage type Ⅱ tympanoplasty.Operation time and rate of tympanic membrane healing were analyzed,as well as pre and post-operative audiometric results.Results There were no complications such as sensorineural hearing loss,facial paralysis or vertigo.The mean operation time was 60.6±7.0 minutes.Average pre-and post-operative air conduction thresholds were 54.70±10.38 dB HL and 35.24±11.66 dBHL,respectively(P<0.001),and average pre and post-operative air-bone gaps were 34.93±9.30 dB and 15.65±7.07dB,respectively(P<0.001).There was no significant difference between pre-and post-operative bone conduction thresholds(P>0.05).Conclusion Endoscopy with continuous irrigation can mitigate some drawbacks of traditional endoscopic ear surgery,such as blurred view by blood as well as thermal injury,and can improve surgery safety and efficiency.In patients with type Ⅲ and Ⅳ tympanosclerosis,an endoscope can be used for close inspection and removal of sclerotic lesions around the stapes with improved visualization provided by continuous irrigation,which is helpful for completing ossicular chain reconstruction in one stage.Short-term outcomes are satisfying,although long-term efficacy remains to be further studied.Compared with under-lay and over-lay methods,the over-inlay technique is relatively new and supposedly can help maintain maximum volume of the tympanic cavity to reduce adhesion and ossicular chain displacement.

关 键 词：鼓室硬化症 耳内镜外科 持续灌流模式 鼓室成形术 外嵌法 

分 类 号：R764[医药卫生—耳鼻咽喉科]