耳内镜下耳屏软骨环-软骨膜修补术治疗鼓膜穿孔40例

Clinical observation of 40 cases of tympanic membrane perforation treated with auricular endoscopic cartilage ring and cartilage membrane repair

目的探讨耳内镜下耳屏软骨环-软骨膜修补术治疗鼓膜穿孔的疗效。方法将80例(80耳)鼓膜穿孔患者按随机数字表法随机分为观察组与对照组各40例,观察组行耳内镜下耳屏软骨环-软骨膜修补术,对照组行显微镜下颞肌筋膜鼓膜修补术。对比两组手术时间、术中出血量、临床疗效、鼓膜愈合率、听力恢复情况及术后并发症发生率。结果观察组与对照组手术时间分别为(42.19±12.35)、(82.67±11.16) min,术中出血量分别为(5.06±1.34)、(14.27±2.35) mL,两组手术时间及术中出血量比较,P均<0.05。观察组治愈28例,有效10例,无效2例,总有效率为95.00%(38/40),对照组分别为23、8、9例,77.50%(31/40),两组总有效率比较,P <0. 05。观察组与对照组术后1个月鼓膜愈合率分别为95. 00%(38/40)、87. 50%(35/40),术后6个月鼓膜愈合率分别为92.50%(37/40)、85.00%(34/40),术后12个月鼓膜愈合率分别为92.50%(37/40)、85.00%(34/40),两组术后1、6、12个月鼓膜愈合率比较,P均>0.05。两组术后1、6、12个月听力恢复情况比较差异无统计学意义(P均>0.05)。观察组术后1年内发生再度穿孔3例(7.5%),对照组术后1年内发生再度穿孔6例(15%),两组术后并发症发生率比较差异无统计学意义(χ~2=0.501,P=0.479)。结论耳内镜下耳屏软骨环-软骨膜修补术治疗鼓膜穿孔效果确切,可促进患者术后恢复,提高临床疗效及鼓膜愈合率,改善患者听力效果。

Objective To investigate the curative effect of endoscopic tragus cartilage ring perichondrium myringoplasty. Methods Eighty patients (80 ears) with tympanic membrane perforation were randomly divided into observation (endoscopic ear cartilage perichondrium composite ring repair) and control groups (temporalis fascia myringoplasty using an operating microscope) , with 40 cases in each group. Clinical indexes, efficacy, tympanic membrane healing rates, hearing recovery, and the incidence of postopera-tive complications were compared between the two groups. Results The operative time and the amount of bleeding in the observa-tion group were lower than those in the control group (P<0.05). The total efficacy rate in the observation group was higher than that in the control group (P<0.05). The tympanic membrane healing rate in the two groups was not statistically different after 1,6, and 12 postoperative months (P>0.05). There was no significant difference in hearing recovery between the two groups after 1,6, and 12 months (P>0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). Conclusion Use of endoscopic ear tragus cartilage ring perichondrium myringoplasty to reduce postoperative bleeding shortens the operative time and healing rate, with good clinical curative effect, and can improve hearing, making it clinically useful.