内窥镜在中耳手术中的应用

Endoscopic Apply in the Middle Ear Surgery

目的 探讨硬性内窥镜在中耳手术中的作用。方法 共56例(侧)患者进行中耳手术+内窥镜术,全部病 例在术前或显微镜下术腔病变清除完毕后,采用0°,30°的硬质内窥镜经外耳道途径或乳突-鼓窦途径分别观察乳 突腔、鼓窦及鼓室各区域,并清除残余病变组织。术后52例随访6～12月。结果 内窥镜下共发现13例 (23.21%)有病变残留,其中鼓膜成形术中0例。改良乳突根治术中5例(23.80%)。乳突根治术中8例 (32.00%)。乳突手术的干耳率为95.56%。结论 (1)术前内窥镜术能评估鼓室病变的情况,为手术方案的制订 提供参考;(2)术中内窥镜术能有效地弥补显微镜视野不足,观察后鼓室、上鼓室前隐窝等隐蔽部位有无病变残留, 有利于彻底清除病变组织,降低复发率;(3)对内窥镜术时存在的问题进行了讨论。

Objective To explore rigid endoscope's value in the middle ear surgery.Methods Fifty-six cases(sides)underwent middle ear surgery and otoendoscopy. Before operation or after the pathologic tissue of the operative cavity was cleared out under the operating microscope,using 0,30 degree rigid endoscopes,the mastoid cavity. The tympanic antrum and the tympanic cavity in all cases were observed via the external ear canal or/and the mastoid-tympanic antrum route. Residual pathologic tissue was cleared out.Fifty-two cases were followed up for 6～12 months after surgery.Results residual pathologic tissue was observed in 13 cases(23.21%).Of them,0 case in myringoplasty,5 cases(23.80%)in modified radical mastoidectomy and 8 cases (32.00%) in radical mastoidectomy.The rate of dry ear in the mastoid surgery was 95.56%.Conclusion (1)Operative otoendoscopy can judge the condition of the tympanic cavity,and provide some basis for the preoperative planning.(2)During middle ear surgery,otoendoscopy can be used as a valuable adjunct to provide visualization into poorly accessible recesses with the operating microscope,and to investigate whether pathologic tissue is left in the poorly accessible recesses which include the retrotympanum,the anterior recess of the supratympanum and so on.Otoendoscopy is advantageous to cleared out pathologic tissue completely and reduce the recurrence rate.(3)The problems of otoendoscopy are also discussed.