耳内镜下保留及重建上鼓室功能中耳手术治疗慢性中耳炎的效果  

Effect of endoscopic preservation and reconstruction of upper tympanum function in middle ear surgery for chronic otitis media

作　　者：牟珊[1] 张勤修[1] 刘志庆[1] 李莎[1] MU Shan;ZHANG Qinxiu;LIU Zhiqing;LI Sha(Department of Otolaryngology,Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610072,China)

机构地区：[1]成都中医药大学附属医院耳鼻喉科,成都610072

出　　处：《中国眼耳鼻喉科杂志》2024年第6期470-474,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的探讨耳内镜下保留及重建上鼓室功能中耳手术的经验和疗效。方法2021年8月—2022年5月我科收治的慢性化脓性中耳炎患者106例(113耳),依据炎症程度及听力情况分为A、B、C 3组,分别在耳内镜下行不同范围开放上鼓室+保留/重建听骨链手术。术后随访6个月以上,观察鼓膜修补成功率、炎症复发率、干耳时间,比较手术前后的平均听阈低频(0.125、0.25 kHz)气导(AC)、语频AC及气骨导差(ABG)。结果所有患耳2个月内获得干耳,无复发感染或再次鼓膜穿孔。A组、B组所有患耳术后ABG<20 dB。C组除1耳听骨链移位未重建,术后听力无改善,其余病例听力都有明显提高。结论耳内镜下施行上鼓室径路保留乳突的鼓室成形术,酌情进行有效的个体化选择,手术更加微创,术后复发率低,听力提高效果好。Objective To explore the experience and effecacy of endoscopic preservation and reconstruction of upper tympanic function in middle ear surgery.Methods From August 2021 to May 2022,a total of 106 cases(113 ears)of chronic suppurative otitis media were divided into three groups(Group A,Group B and Group C)according to the degree of inflammation and hearing condition.Different ranges of opening upper tympanic cavity and preservation/reconstruction of ossicular chain surgery were performed under otoscopy.Follow-up for more than 6 months was conducted to observe the success rate of tympanic membrane repair,recurrence rate of inflammation,and dry ear time after surgery.The differences in average hearing threshold at low frequency(0.125,0.25 kHz)air conductance(AC),speech frequency AC,and airbone gap(ABG)were compared before and after the operation.Results All affected ears obtained dryness within 2 months without recurrence of infection or re-perforation of the tympanic membrane.The ABG<20 dB was observed in all patients in Group A and Group B after ear surgery.In Group C,significant improvements in hearing were observed in all cases except one ear with displacement of the ossicular chain and not reconstructed.Conclusion Endoscopic tympanoplasty with preservation of the mastoid process through the upper tympanic pathway can be performed effectively with appropriate individualized selection,resulting in minimally invasive surgery with lower postoperative recurrence rate and improved hearing.

关 键 词：慢性中耳炎 耳内镜 上鼓室功能 鼓室成形术 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]