耳内镜下不翻外耳道鼓膜瓣内置法鼓膜修补术临床疗效观察  

Clinical efficiency of endoscopic myringoplasty utilizing“push-trough”technique without tympanomeatal flap elevation

作　　者：余利波 郑永波[1] 任建君[1] 杨文 周鹏[1] 李波[1] 赵宇[1] YU Libo;ZHENG Yongbo;REN Jianjun;YANG Wen;ZHOU Peng;LI Bo;ZHAO Yu(Department of Otorhinolaryngology-Head&Neck Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院耳鼻咽喉-头颈外科,成都610041

出　　处：《中国眼耳鼻喉科杂志》2023年第3期238-242,247,共6页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的观察并探讨耳内镜下不翻外耳道鼓膜瓣内置法行鼓膜修补术的临床疗效。方法纳入2018年1月~2021年11月期间在我科行耳内镜下不翻外耳道鼓膜瓣内置法鼓膜修补术的患者133例,观察术后鼓膜穿孔愈合及听力改善情况。术前行颞骨高分辨薄层CT扫描、耳内镜检查、纯音听阈测试及其他相关检查。术后半个月、1个月、3个月随访复查,耳内镜检查观察鼓膜穿孔的愈合情况,纯音测听评估听力。采用R version 3.6.3软件进行统计分析。结果术后3个月,96.2%(128/133)患者的鼓膜穿孔完全愈合,5例未完全愈合,但均比术前明显减小。鼓膜穿孔的大小和类型、穿孔边缘是否有钙化斑均不影响穿孔的愈合。平均手术时间<30 min,出血量<1 mL。术前、术后气骨导差分别为(23.3±8.93)dB HL和(13.3±7.43)dB HL,显著改善(10.0±8.30)dB HL,差异有统计学意义(P<0.001,秩和检验)。结论耳内镜下不翻外耳道鼓膜瓣内置法修补鼓膜穿孔,鼓膜愈合率高、手术时间短、出血量少、听力恢复可。Objective To evaluate the clinical efficiency of endoscopic myringoplasty utilizing cartilage graft“push-through”technique without tympanomeatal flap elevation.Methods A total of 133 patients who had received endoscopic myringoplasty without tympanomeatal flap elevation in our department from January 2018 to November 2021 were included.The recovery of tympanic membrane and hearing after surgery were examined using“before-after study in the same patient”design.Preoperative high-resolution computed tomography(HRCT)of temporal bone,endoscopic ear examination,pure tone audiometry and other routine examinations were performed.The outcomes included graft success evaluated by endoscopy and hearing gain evaluated by pure tone audiometry at 0.5,1 and 3 months after the surgery.The therapeutic efficiency was analyzed using R software(version 3.6.3).Results Three months after the surgery,the graft success rate achieved 96.2%(128/133).Five patients encountered reperforation,but the diameters were significantly smaller than those observed preoperatively.The mean preoperative air-bone gap[ABG;(23.3±8.93)dB HL]was significantly greater than postoperatively[(13.3±7.43)dB HL]at 3 months(P<0.001).Besides,the size and types of tympanic membrane perforation or calcification spots at the edge of tympanic membrane perforation all had no role in the healing rates of tympanic membrane.Moreover,the average operation time was<30 minutes and the average blood loss was<1 mL.Conclusions Endoscopic myringoplasty without tympanomeatal flap elevation had the advantages of high healing rate,short operation time,few bleeding and good restoration of hearing.

关 键 词：鼓膜穿孔 不翻外耳道鼓膜瓣 软骨-软骨膜移植物 

分 类 号：R764.8[医药卫生—耳鼻咽喉科] R764.92[医药卫生—临床医学]