耳内窥镜下利用耳屏软骨-软骨膜瓣鼓膜修补术治疗鼓膜穿孔的效果

Effect of tragus cartilage-perichondrium flap tympanoplasty under otoendoscope for tympanic membrane perforation

目的探讨耳内窥镜下应用耳屏软骨-软骨膜瓣鼓膜修补术治疗鼓膜穿孔的效果。方法将本院64例鼓膜穿孔患者(均为单耳)随机分为对照组和观察组,各32例。对照组在显微镜下行耳屏软骨-软骨膜瓣鼓膜修补术,观察组在耳内窥镜下行鼓膜修补术。比较两组患者的治疗效果。结果两组患者的术中出血量无显著差异(P>0.05);在大、中鼓膜穿孔手术中,观察组的手术时间明显短于对照组(P<0.05);在小鼓膜穿孔手术中,两组患者的手术时间无显著差异(P>0.05);术后1个月,观察组的鼓膜愈合率明显高于对照组(P<0.05);术后3、6个月,两组患者的气骨导差水平均显著改善,且观察组患者术后3个月的气骨导差水平明显优于对照组(P<0.05)。结论耳内窥镜下利用耳屏软骨-软骨膜瓣鼓膜穿孔修补术能够有效缩短大、中穿孔手术时间,缩短鼓膜愈合时间,改善患者听力,安全有效,值得临床推广。

Objective To investigate the effect of tragus cartilage-perichondrium flap tympanoplasty under otoendoscope for tympanic membrane perforation.Methods Sixty-four patients with tympanic membrane perforation (single ear) in our hospital were randomly divided into control group and observation group, with 32 cases in each group.The control group underwent tragus cartilage-perichondrium flap tympanoplasty under microscope, while the observation group underwent tympanoplasty under otoscope.The treatment effects of the two groups were compared.Results There was no significant difference in intraoperative bleeding volume between the two groups(P>0.05).In the operation of large and middle tympanic membrane perforation, the operation time of the observation group were significantly shorter than those of the control group(P<0.05);in the operation of small tympanic membrane perforation, there was no significant difference in operation time between the two groups (P>0.05).At 1 month after operation, the healing rate of tympanic membrane in the observation group was significantly higher than that in the control group(P<0.05).At 3 and 6 months after operation, the level of air-bone gaps of both groups improved significantly, and that of the observation group was significantly better than the control group at 3 months after operation(P<0.05).Conclusion Tragus cartilage-perichondrium flap tympanoplasty under otoendoscope for tympanic membrane perforation can effectively shorten the operation time of large and medium perforation, shorten the healing time of tympanic membrane and improve patients' hearing, which is safe, effective and worthy of clinical promotion.