耳内镜下镫骨手术治疗耳硬化症疗效探讨

Clinical Outcomes of Endoscopic Transmeatal Stapes Surgery for Otosclerosis

目的探讨耳内镜下镫骨手术治疗耳硬化症的临床疗效。方法回顾性选取2018年1月至2020年12月深圳市龙岗区耳鼻咽喉医院耳外科收治的耳内镜下行镫骨手术耳硬化症患者85例,分析患者一般资料、临床疗效、随访结果。结果85例患者均于耳内镜下顺利完成手术。右耳后鼓室暴露难度、鼓索神经操作例数均高于左耳,差异均有统计学意义(P<0.05);右耳镫骨底板打孔方式与左耳比较,差异无统计学意义(P>0.05);右耳术后眩晕、味觉障碍、迟发性面瘫与左耳比较,差异无统计学意义(P>0.05),右耳术后并发症总例数高于左耳,差异有统计学意义(P<0.05);右耳术前、术后气骨导差均值与左耳比较,差异均无统计学意义(P>0.05)。术后平均气导阈值、平均气骨导差值均低于术前(P<0.001)。术后2000 Hz骨导阈值低于术前(P<0.05);术后4000 Hz骨导阈值高于术前(P<0.05);术后500、1000 Hz骨导阈值与术前比较,差异均无统计学意义(P>0.05)。结论耳内镜下镫骨手术治疗耳硬化症安全有效,创伤小、视野清晰。右耳镫骨手术中视野暴露较困难,鼓索神经损伤率增加。

Objective To report outcomes of endoscopic transmeatal stapes surgery for otosclerosis.Methods Clinical data of 85 cases of otosclerosis treated by endoscopic transmeatal stapes surgery from January 2018 to December 2020 in Shenzhen Longgang Otolaryngology Hospital were retrospectively analyzed,including general information,postoperative hearing outcomes and surgical complications.Results Surgery was successful in all 85 cases.Exposure of the tympanic cavity and manipulation of the corda tympani were somewhat more difficult in the right ear than in the left ear(P<0.05),but not for fenestration of the stapes footplate(P>0.05).Postoperative vertigo,taste disturbance and delayed facial paralysis showed no difference for surgery side(P>0.05),although total number of complications in the right ear was higher than that in the left ear(P<0.05).Postoperative air bone gap(ABG)improvement was similar between the two sides(P>0.05),with both air conduction threshold and ABG showing improvement(P<0.001).Postoperative bone conduction thresholds improved at 2 kHz(P<0.05),but showed elevation at 4 kHz(P<0.05),while showing no significant change at 0.5 or 1 kHz(P>0.05).Conclusion Endoscopic transmeatal stapes surgery is minimally invasive and safe,although may present somewhat more difficult exposure in the right ear with potentially increased incidence of chorda tympani injury.