耳内镜下中耳手术及鼓室成形术效果分析

Feasibility and Efficacy of Endoscopic Middle Ear Surgery and Tympanoplasty

目的探讨耳内镜下鼓室成形的可行性及疗效。方法回顾性分析2016年5月至2017年4月我科采用耳内镜下对42例慢性化脓性中耳炎、上鼓室胆脂瘤及鼓室硬化症的患者进行鼓室探查、上鼓室进路乳突根治加鼓室成型术,观察鼓膜愈合成功率,并比较手术前及手术后3个月平均气导听阈(PTA)及气骨导差(A-B gap)。结果42例患者术后鼓膜一期完全愈合40例(占95.2%),遗留穿孔2例(占4.8%)者均在门诊耳内镜下处理后完全愈合。术前患者平均气导听阈52.32±14.70 d B HL,术后3个月平均气导听阈30.59±12.16 d B HL,听力提高程度具有统计学意义(P<0.001)。3例患者术后出现皮瓣部分缺血坏死,经门诊处理后恢复。未出现严重感音神经性耳聋,无面瘫及眩晕并发症。结论:耳内镜下中耳手术及鼓室成形术具有良好的可行性。部分经过选择的中耳胆脂瘤也适合耳内镜下进行。耳内镜下具有视野广阔清晰,手术时间较短、术中出血量少、术后恢复快及听力效果良好、并发症少等优点,是未来中耳手术的一个热点及方向,但单手操作等缺点仍需术者熟练克服。

Objective To investigate the feasibility and efficacy of endoscopic tympanoplasty. Methods This was a retrospective study including 42 patients with chronic suppurative otitis, attic cholesteatoma or tympanosclerosis who received endoscopic tympanoplasty. Graft success rate and audiometric improvement after surgery were assessed. Results The overall graft take rate was 95.2%（40/42）. Perforation in two cases were completely healed after additional endoscopic treatment in the outpatient office. Mean air-bone gap before surgery was 52.32 ± 14.70 d B and improved to30.59±12.16 d B after surgery（P0.001）. Partial flap necrosis was seen in 3 cases and recovered after appropriate treatment. There were no complications such as severe sensoneural hearing loss, facial paralysis or vertigo. Conclusions Our study demonstrates that endoscopic tympanoplasty can be effectively applied in middle ear surgery, including for cases of attic cholesteatoma. A better view of the middle ear can be acquired during endoscopic surgery compared to microscopic surgery, facilitating preservation of non-diseased structures. In addition, endoscopic surgery requires smaller incisions and less medical expenditures and provides better hearing improvement. Although endoscopic middle surgery carries promises in the future, disadvantages such as single-hand operation need to be overcome.