耳内窥镜与显微镜下鼓膜修补术治疗鼓膜穿孔疗效比较

Comparison of the effect of ear endoscopic and microscopic tympanic membrane repairing in the treatment of tympanic membrane perforation

目的比较耳内窥镜与显微镜下鼓膜修补术治疗鼓膜穿孔的临床效果。方法选择2013年1月至2016年1月周口市中医院收治的鼓膜穿孔患者114例,其中56例患者在显微镜下完成鼓膜修补术(显微镜组),58例患者在耳内窥镜下完成鼓膜修补术(内窥镜组),比较2组患者的手术时间、术中出血量及术后听力恢复情况。结果内窥镜组中、小鼓膜穿孔患者的手术时间显著短于显微镜组(P<0.05),但2组大穿孔患者的手术时间比较差异无统计学意义(P>0.05);2组患者术中出血量比较差异无统计学意义(P>0.05)。术后3个月,显微镜组和内窥镜组患者鼓膜愈合率分别为89.3%(50/56)、94.8%(55/58),2组患者鼓膜愈合率比较差异无统计学意义(P>0.05)。治疗前2组患者纯音听阈比较差异无统计学意义(P>0.05);术后3个月,2组患者纯音听阈显著低于治疗前(P<0.05),内窥镜组小、中穿孔患者的纯音听阈显著低于显微镜组(P<0.05),但2组大穿孔患者纯音听阈比较差异无统计学意义(P>0.05)。结论耳内窥镜与显微镜下鼓膜修补术治疗鼓膜穿孔均可显著改善患者听力,但对于小、中鼓膜穿孔,耳内窥镜下鼓膜修补术的临床效果优于显微镜下鼓膜修补术。

Objective To compare the clinical effect of ear endoscopic and microscopic tympanic membrane repairing in the treatment of tympanic membrane perforation. Methods A total of 114 patients with tympanic membrane perforation were selected from January 2013 to January 2016 in Zhoukou Hospital of Traditional Chinese Medicine. Among the patients,56 patients were treated with microscopic tympanic membrane repairing（ microscope group）,58 patients were treated with endoscopic tympanic membrane repairing（ endoscope group）. The operation time,intraoperative blood loss and auditory rehabilitation were compared between the two groups. Results The operation time of the middle and small tympanic membrane perforation in the endoscope group was significantly shorter than that in the microscopy group（ P〉0. 05）,but there was no significant difference in the operation time of patients with large tympanic membrane perforation between the two groups（ P〉0. 05）.There was no significant difference in intraoperative blood loss between the two groups（ P〈0. 05）. Three months after operation,the healing rate of tympanic membrane in the microscope group and endoscope group was 89. 3%（ 50/56） and 94. 8%（ 55/58） respectively,there was no significant difference in the healing rate of tympanic membrane between the two groups（ P〈0. 05）. There was no significant difference in the pure tone auditory threshold between the two groups before treatment（ P〈0. 05）. The pure tone auditory threshold three months after treatment was significantly lower than that before treatment in the two groups（ P〈0. 05）. Three months after operation,the pure tone auditory threshold of patients with small and middle tympanic membrane perforation in the endoscope group was significantly lower than that in the microscope group（ P〈0. 05）,but there was no significant difference in the pure tone auditory threshold of patients with large tympanic membrane perforation between the two groups（ P〉0. 05）. Conclusion Ear endoscopic and microscopic tympanic membrane repairing in the treatment of tympanic membrane perforation can significantly improve the hearing of patients. But the clinical effect of endoscopic tympanic membrane repairing is better than that of microscopic tympanic membrane repairing in patients with small and middle tympanic membrane perforation.