耳内镜下鼓室成形术治疗粘连性中耳炎疗效分析  

Endoscopic tympanoplasty for adhesive otitis media

作　　者：王冰[1] 张瑾[1] 李陈 刘晖[1] 张文[1] WANG Bing;ZHANG Jin;LI Chen;LIU Hui;ZHANG Wen(Department of Otolaryngology,Shaanxi Provincial People’s Hospital,Xi’an 710068,China)

机构地区：[1]陕西省人民医院耳鼻咽喉头颈外科,西安710068

出　　处：《中国眼耳鼻喉科杂志》2023年第4期304-308,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的分析粘连性中耳炎的临床特点以及全耳内镜下经外耳道鼓室成形术治疗粘连性中耳炎的短期疗效。方法回顾分析我科2019年2月—2022年1月收治并行鼓室成形术的粘连性中耳炎患者55例(58耳),其中男性27例、女性28例,年龄15~72岁。48耳为单纯紧张部粘连;10耳包含松弛部及上鼓室病变,其中5耳松弛部内陷粘连、5耳松弛部胆脂瘤及肉芽。手术均采用全耳内镜下经外耳道入路,耳屏软骨-软骨膜复合物为移植材料,根据病变范围行不同类型的鼓室成形术和上鼓室重建。其中35例行Ⅰ型鼓室成形术,17例行Ⅱ型鼓室成形术,4例行Ⅲ型鼓室成形术,2例行鼓室成形+咽鼓管球囊扩张术。术后1个月、3个月、6个月、1年复查。观察患者术后症状、鼓膜愈合率、听力改善情况及并发症。结果随访期内所有患者无耳流水、流脓。鼓膜愈合率为94.8%(55/58);术后平均气导听阈(35.74±15.15)dB HL较术前(48.05±15.18)dB HL提高,差异有统计学意义(P<0.05);术后平均气骨导差[(13.67±7.68)dB HL]较术前[(22.19±9.73)dB HL]缩小,差异具有统计学意义(P<0.05)。所有患者无二次手术,无面瘫等并发症。结论全耳内镜下经外耳道鼓室成形术治疗粘连性中耳炎是一种安全有效的手术方式。Objective To analyze the clinical characters of adhesive otitis media(AdOM)and the short-term efficacy of oto-endoscopic tympanoplasy through the external auditory canal on the treatment of AdOM.Methods From February 2019 to January 2022,55 patients(58 ears)with adhesive otitis media who had undergone oto-endoscopic tympanoplasty in our department were retrospectively analyzed,including 27 males and 28 females,aged 15-72 years.Among them,48 ears had simple tension adhesion,10 ears contained lesions in the relaxation region and the upper tympanic chamber,including 5 ears with invaginated adhesion in the relaxation region,5 ears with cholesteatoma and granulation in the relaxation region.All the operations were performed through the external auditory canal under oto-endoscopy,with the tragus cartilage perichondrium composite as the graft material.Different types of tympanoplasty were performed according to the extent of lesions.Among them,35 cases underwent typeⅠtympanoplasty,17 cases underwent typeⅡtympanoplasty,4 cases underwent typeⅢtympanoplasty,and 2 cases underwent tympanoplasty and balloon dilatation of the eustachian tube.All patients were followed up at 1 month,3 months,6 months,and 1 year after surgery.Postoperative symptoms,healing rate of tympanic membrane,improvement of hearing,and complications were observed.Results During the follow-up period,all patients had no pus discharge.The healing rate of tympanic membrane was 94.8%(55/58).The average air conduction hearing threshold after surgery was(35.74±15.15)dB HL,which was significantly higher than that before surgery[(48.05±15.18)dB HL](P<0.05).The average air bone gap after surgery was(13.67±7.68)dB HL,which was significantly smaller than that before surgery(22.19±9.73)dB HL(P<0.05).All patients had no complications such as facial poralysis,or had secondary surgery.Conclusions Oto-endoscopic tympanoplasty through the external auditory canal is a safe and effective surgical method for the treatment of AdOM.

关 键 词：粘连性中耳炎 耳内镜 鼓室成形术 

分 类 号：R764.2[医药卫生—耳鼻咽喉科]