耳内镜下鼓膜修补术与显微镜下鼓膜修补术的比较

Tympanic membrane repair under oto-endoscope vesus under microscope

目的探讨耳内镜下鼓膜修补术与显微镜下鼓膜修补术的应用价值。方法选择耳鼻喉科2014年8月至2016年8月收治的慢性化脓性中耳炎鼓膜穿孔患者126例为研究对象,按照随机数表法分为观察组与对照组,各63例。观察组行耳内镜下鼓膜修补术,对照组行显微镜下鼓膜修补术。比较两组患者手术时间、术中出血量、术后住院时间、术后疼痛、术后切口美观度、听力恢复情况及临床治疗效果。结果观察组手术时间[(58.8±17.6)min vs(93.4±25.7)min]、术中出血量[(6.7±2.5)ml vs(14.3±4.4)ml]和术后住院时间[(3.5±0.6)d vs(4.4±0.8)d]均低于对照组,差异有统计学意义(P均<0.01);观察组术后疼痛程度低于对照组,差异有统计学意义(P<0.01);观察组对美观的满意度优于对照组(92.06%vs 79.37%),差异有统计学意义(P<0.05);听力提高情况和总有效率两组比较差异无统计学意义(P均>0.05);两组患者均未出现眩晕、面瘫等手术并发症,治愈患者随访1年,未再发现鼓膜穿孔现象。结论耳内镜下鼓膜修补术与显微镜下鼓膜修补术均有良好的治疗效果。且耳内镜下鼓膜修补术具有手术时间短、对患者创伤小、术后恢复快、术后疼痛轻、切口美观度好等优势。在难以暴露的、复杂的视野内,两者合用可能会取得更好的治疗效果。

Objective To investigate the application value of oto-endoscopic tympanic membrane repair（ TMr） and microscopic tympanic membrane repair. Methods A total of 126 patients with tympanic membrane perforation in chronic suppurative otitis media from August 2014 to August 2016 were selected as the research objects and randomly divided into experimental group and control group（ n = 63,each）. Oto-endoscopic TMr was performed in experimental group,and microscopic TMr was performed in control group. The operative time,intraoperative blood loss,postoperative hospital stay,postoperative pain,postoperative incision aesthetics,hearing recovery and clinical effect were compared between two groups.Results The operative time[（ 58. 8 ± 17. 6） min vs（ 93. 4 ± 25. 7） min],operative bleeding[（ 6. 7 ± 2. 5） ml vs（ 14. 3 ±4. 4） ml] and postoperative hospitalization time[（ 3. 5 ± 0. 6） d vs（ 4. 4 ± 0. 8） d] in experimental group were significantly lower than those in control group（ all P〈0. 01）. The degree of pain in experimental group was lower than that in control group（ P〈0. 01）,and the satisfaction degree with beauty in experimental group was better than that in control group（ 92. 06% vs 79. 37%,P〈0. 05）. There were no significant difference in hearing improvement and total efficiency between two groups（ all P〈0. 05）. No complications such as vertigo and facial paralysis occurred in two groups,and no more perforation of tympanic membrane occurred during 1-year follow-up in cured patients. Conclusions Both endoscopic myringoplasty and microscopic myringoplasty have good therapeutic effect. Compared with microscopic myringoplasty,endotoscopic myringoplasty has advantages in reducing the operation time and trauma to the patient and promoting postoperative recovery,alleviating postoperative pain and improving incision appearance and so on. In the difficult and complex field of vision,the combination of two method can achieve better therapeutic effects.