持续灌流模式耳内镜下微瓣外植法鼓膜成形术临床疗效分析  

Clinical Analysis of Micro-flap Overlay Myringoplasty under Continuous Irrigatting Mode of Endoscopic Ear Surgery(CIM-EES)

作　　者：廖华[1] 杨希林[1] 王文静[1] 汪雷[1] 徐勇[1] 任杰[1] Liao Hua;Yang Xilin;Wang Wenjing;Wang Lei;Xu Yong;Ren Jie(Otorhinolaryngology Head and Neck Surgery Center of 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中心,武汉430060

出　　处：《听力学及言语疾病杂志》2023年第4期329-332,共4页Journal of Audiology and Speech Pathology

摘　　要：目的评价耳内镜持续灌流模式下微瓣外植法鼓膜成形术的临床疗效。方法采用回顾性研究,将75例(79耳)行鼓膜成形术的慢性化脓性中耳炎患者按外耳道皮瓣制作方式不同分为微型皮瓣组(43例,45耳)和常规皮瓣组(32例,34耳)。两组均采用持续灌流模式耳内镜手术(continuous irrigating mode of ear endoscopic surgery,CIM-EES),以耳屏软骨-软骨膜复合物为鼓膜修复材料,外植法完成鼓膜成形术,术后随访6~12个月,比较两组患者的手术时间及术后疗效。结果两组患者鼓膜均一期修复成功,手术成功率为100%。微型皮瓣组和常规皮瓣组平均手术时间分别为19.6±6.5和39.1±9.9 min,差异有统计学意义(P<0.001);两组患者术前0.5~4 kHz平均听阈分别为40.16±10.79和41.58±9.23 dB HL,气骨导差分别为21.86±5.44和23.02±6.15 dB;术后6个月平均听阈分别为25.56±11.21和26.47±10.59 dB HL,气骨差分别为7.33±2.79和8.09±5.73 dB,均较术前显著改善(P<0.001),两组间差异均无统计学意义(P>0.05)。结论持续灌流模式耳内镜下微瓣外植法鼓膜成形术的手术成功率极高,临床疗效好,微型皮瓣通过缩小剥离皮瓣的体积和范围可显著缩短手术时间。Objective To evaluate the clinical effects of endoscopic micro-flap overlay myringoplasty under continuous irrigatting mode of endoscopic ear surgery(CIM-EES).Methods 75 patients with chronic suppurative otitis media that planned to receive myringoplasty were divided into micro-flap group(43 cases,45 ears)and conventional flap with normal flap group(32 cases,34 ears)according to different methods of tympanomeatal flap.Both groups were treated under CIM-EES with overlay method.Tragus cartilage-perichondrium complex was choosed as the repairing material.Postoperative follow-up was 6~12 months.The operation time and postoperative clinical efficacy of the two groups were compared and analyzed.Results The tympanic membrane were repaired successfully in all patients in both the micro-flap group and the conventional flap group that manifested the success rate of the operation under CIM-EES was 100%.The mean operation time was 19.6±6.5 min and 39.1±9.9 min,respectively,and the difference was statistically significant(P<0.001).The mean air conduction threshold of 0.5~4 kHz before operation was 40.16±10.79 dB HL and 41.58±9.23 dB HL,respectively,and the mean air conduction auditory threshold of 0.5~4 kHz 6 months after operation was 25.56±11.21 dB HL and 26.47±10.59 dB HL,respectively.The air conduction hearing among the two groups were both significantly improved after operation comparing with operation before(P<0.001),and there was no statistical significance between the two groups(P>0.05).Conclusion Micro-flap overlay myringoplasty under CIM-EES has a very high success rate of surgery.Comparing with the tympanomeatal flap with normal size,micro-flap can significantly shorten the operation time.

关 键 词：微型皮瓣 持续灌流模式 鼓膜成形术 外植法 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]