耳内镜下耳屏软骨膜双瓣鼓膜修补术治疗鼓膜大穿孔的临床疗效及预后随访研究  

Clinical efficacy and prognostic follow-up study of double flap tympanic membrane repair with tragus and perichondrium under otoscope for treatment of large perforation of tympanic membrane

作　　者：刘原宙 陈艳丹[1] LIU Yuanzhou;CHEN Yandan(Huangshi Central Hospital,Affiliated Hospital of Hubei Institute of Technology,Huangshi 435000,China)

机构地区：[1]湖北省黄石市中心医院(湖北理工学院附属医院),435000

出　　处：《中国煤炭工业医学杂志》2023年第5期507-512,共6页Chinese Journal of Coal Industry Medicine

基　　金：湖北省卫生健康委联合基金项目(编号:WJ2019H450)。

摘　　要：目的本研究探讨临床上应用耳内镜下耳屏软骨膜双瓣鼓膜修补术治疗鼓膜大穿孔的方法及效果。方法选择2019年12月—2021年10月河池市第一人民医院耳鼻喉科门诊收治的外伤性鼓膜穿孔患者80例作为研究对象,采取随机数字表法分为观察组和对照组,每组40例,对照组予以保守治疗,观察组予以经耳内镜下耳屏软骨-软骨膜鼓膜修补、重组表皮生长因子与微波治疗,对比二组临床疗效及治疗后并发症的差异,采用丹麦听力计AD226进行常频纯音测听及扩展高频测听检查。结果术后4周观察组患者在0.25、4.0、8.0kHZ下听力阈值显著低于对照组(P<0.05);二组患者其余频率的听力阈值比较差异无统计学意义(P>0.05);观察组患者在2.0、4.0kHZ下的骨导听力阈值和10.0、12.0、16.0kHZ下的扩展高频听阈值均低于对照组(P<0.05);鼓膜平均愈合时间观察组(12.5±2.0)d短于对照组(14.4±2.4)d,差异有统计学意义(P<0.05);治疗4周后,观察组患者的治愈率为75.00%、好转率为25.00%,对照组的治愈率为55.00%、好转率为42.50%、无效率为2.50%,二组治疗效果差异无统计学意义(P>0.05)。二组患者手术过程中及术后观察,均未出现严重的手术并发症,对照组有1例患者术后出现外耳道轻度感染,给予清洗及抗感染治疗后治愈。结论与常规方案相比,经耳内镜下耳屏软骨-软骨膜鼓膜修补、重组表皮生长因子与微波治疗鼓膜大穿孔能有效缩短鼓膜愈合时间,对术后听力改善效果更好。Objective This study explores the clinical application of ear endoscope assisted double flap tympanic membrane repair surgery for the treatment of large perforation of the tympanic membrane.Methods From December 2019 to October 2021,eighty patients with traumatic tympanic membrane perforations were admitted to the outpatient department of otolaryngology at Hechi First People's Hospital.They were randomly divided into an observation group and a control group using a random number allocation method,with 40 patients in each group.The control group received conservative treatment,while the observation group received endoscopic tympanic membrane repair with tragus cartilage-perichondrium grafting,recombinant epidermal growth factor,and microwave therapy.The clinical efficacy and post-treatment complications were compared between the two groups.Pure-tone hearing thresholds were measured using a Danish hearing tester AD226 for both ears,and high-frequency hearing thresholds were also evaluated.Results Four weeks after surgery,the hearing thresholds at 0.25,4.0,and 8.0 kHZ in the observation group were significantly lower than those in the control group(P<0.05).There were no significant differences in hearing thresholds at other frequencies between the two groups(P>0.05).The bone conduction hearing thresholds at 2.0 and 4.0 kHZ and the extended high-frequency hearing thresholds at 10.0,12.0,and 16.0 kHZ in the observation group were lower than those in the control group(P<0.05).The average healing time of the tympanic membrane in the observation group(12.5±2.0)days was shorter than that in the control group(14.4±2.4)days(P<0.05).Four weeks after treatment,the cure rate was 75.00%and the improvement rate was 25.00%in the observation group,while the cure rate was 55.00%and the improvement rate was 42.50%with no inefficiency in the control group,with no significant difference between the two groups(P>0.05).No serious surgical complications occurred during the operation and post-operation observation in both groups.One pat

关 键 词：耳内镜 耳屏软骨膜双瓣鼓膜修补术 鼓膜大穿孔 重组表皮生长因子 微波治疗 

分 类 号：R74[医药卫生—神经病学与精神病学]