耳内镜下手术治疗单纯先天性中耳畸形疗效分析  

Clinical analysis of transcanal endoscopic ear surgery for single congenital middle ear malformations

作　　者：施丽彩 方路成 陈帅男[1] 黄益灯[1] SHI Licai;FANG Lucheng;CHEN Shuainan;HUANG Yideng(Department of Otolaryngology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China)

机构地区：[1]温州医科大学附属第一医院耳鼻咽喉科,浙江温州325015

出　　处：《温州医科大学学报》2022年第7期545-549,共5页Journal of Wenzhou Medical University

基　　金：国家自然科学基金项目(82171146);浙江省自然科学基金重点项目(LZ22H130001)。

摘　　要：目的:探讨单用耳内镜手术治疗单纯先天性中耳畸形的疗效。方法:回顾性分析2017年1月至2021年6月在温州医科大学附属第一医院收治的27例单纯先天性中耳畸形患者的临床资料,对术前高分辨率计算机断层扫描结果、术中所见、手术方式及术前后听力学资料进行分析。结果:27例患者均为单耳发病,24例患者为传导性聋,3例混合性聋且以传导性为主。Teunissen-Cremers分型I型5例,II型6例,III型15例,IV型1例。术中分别使用PORP 8例、TORP 7例和Piston 11例行听骨链重建术。1例IV型患者系前庭窗闭锁,听骨及面神经严重畸形,行加长的7.0 mm Piston锤骨前庭桥接术。27例患者术前平均气导为(62.1±8.3)dB HL,术后6个月平均气导为(30.6±7.4)dB HL(t=19.47,P<0.001)。15例(55.6%)气导听力提高超过30 dB HL。术前平均气骨导差为(43.1±9.3)dB HL,术后6个月为(13.4±5.2)dB HL(t=16.75,P<0.001)。结论:单纯先天性中耳畸形主要表现为听骨链畸形,单用耳内镜诊治先天性中耳畸形具有视野清晰、操作准确、无需外耳道或耳后切口、创伤小、并发症少、术后听力恢复好的优点。Objective:To describe the operative findings and analyze the surgical effect of endoscopic ear surgery for congenital middle ear malformations.Methods:From January 2017 to June 2021,a retrospective study was performed on 27 patients with congenital middle ear malformations who underwent endoscopic surgery.Demographic data,high-resolution computed tomography findings,intraoperative findings,surgical management and audiometric data were recorded.Results:Altogether 27 patients with congenital middle ear malformations were included,consisting of 3 cases unilateral mixed hearing loss with significant conductive hearing loss and 24 cases unilateral conductive hearing loss.Anomalies were categorized according to the Teunissen and Cremers classification system:5 ears were categorized as class I,6 ears as class II,15 ears as class III and 1 ear as class IV.Prostheses used in surgery included 8 PORPs,7 TORPs and 11 Pistons.One patient was type IV,with vestibular window atresia,facial nerve malformation,and malleostapedotomy was performed with lengthened 7mm Piston to reconstruct ossicular chain.The air conduction pure tone average was(62.1±8.3)dB HL preoperatively and(30.6±7.4)dB HL postoperatively(t=19.47,P<0.001).Fifteen cases(55.6%)acquired an air conduction hearing gain exceeding 30 dB HL.Mean air-bone gap(ABG)was(43.1±9.3)dB HL preoperatively and(13.4±5.2)dB HL postoperatively(t=16.75,P<0.001).Twenty-five cases(93%)showed a postoperative ABG of less than 20 dB after operation.Conclusion:Simple congenital middle ear deformity is mainly manifested as a listening bone chain deformity.The ear endoscopy alone for the diagnosis and treatment of congenital middle ear malformation has the advantages of a clear field of vision,accurate manipulation,no need for external ear canal or posterior ear incision,small wound,few complications,good postoperative hearing recovery.

关 键 词：先天性畸形 中耳 听小骨 内镜外科手术 治疗效果 

分 类 号：R964[医药卫生—药理学]