耳内镜下同期双侧鼓室成形术疗效观察

Outcomes of same-day bilateral endoscopic tympanoplasty

目的:探讨耳内镜下双侧同期鼓室成形术的可行性及疗效。方法:对15例(30耳)双侧慢性化脓性中耳炎患者行耳内镜下双侧同期鼓室成形术,将病变较重侧作为第一手术耳优先手术,对侧耳为第二手术耳;共完成鼓室成形术Ⅰ型22耳、鼓室成形术Ⅱ型5耳、鼓室成形术Ⅲ型3耳,其中第二手术耳(15耳)均施行鼓室成形术Ⅰ型。术中取用第一手术耳侧的耳屏软骨-软骨膜瓣作为双侧鼓膜修复材料。以术后6个月耳内镜下鼓膜情况及纯音听阈结果评估鼓膜愈合成功率及术后听力改善程度。结果:15例(30耳)患者术后鼓膜一期完全愈合29耳(96.7%),其中第一手术耳14耳,愈合率93.3%(14/15),第二手术耳15耳,愈合率100.0%(15/15)。平均气导听阈由术前(50.9±9.1)dB HL提高到(32.0±6.0)dB HL,平均气骨导差由术前(30.2±7.9)dB HL缩小到(13.7±6.0)dB HL,术前术后比较,差异均有统计学意义(均P<0.01)。结论:耳内镜下鼓室成形术具有精细、微创的特点,选择适当病例可以在耳内镜下同期完成双侧鼓室成形术,疗效满意,无严重并发症发生,同时能缩短手术时间,降低医疗成本,值得临床推广。

Objective：To investigate the feasibility of simultaneous bilateral endoscopic for tympanoplasty in patients with bilateral chronic suppurative otitis media.Method：Fifteen patients（30 ears）with bilateral chronic suppurative otitis media who underwent bilateral endoscopic transcanal tympanoplasty on the same day were enrolled in this study.The ear with worse-hearing was selected as the first operation side,the contralateral ear as the second one.The operation group consisted of 22 ears of Type 1 tympanoplasty,5 ears of Type 2 tympanoplasty and 3 ears of Type 3 tympanoplasty.All second sides（15 ears）underwent Type 1 tympanoplasty.The cartilageperichondrium graft was harvested from the tragal of the first side and was cut in two halves which could be used for the both sides.The graft success and hearing improvement were evaluated at the postoperative 6 th month according to the follow up results of the endoscopic image and the pure-tone audiometry.Result：The graft take rate was 96.7%（27/30）without any retraction pockets or displaced grafts.The graft take rate of the first side was93.3%（14/15）,and the one of the second side was 100.0%（15/15）.The average air conduction thresholds were（50.9±9.1）dB HL preoperatively and（32.0±6.0）dB HL postoperatively（P0.01）.The average air-bone gap overall improved from（30.2±7.9）dB HL preoperatively to（13.7±6.0）dB HL postoperatively（P0.01）.Conclusion：Bilateral same-day endoscopic tympanoplasty are safe and cost effective in appropriately selected patients.It can offer favorable out-comes in selected patients with chronic suppurative otitis media.