耳内镜下鼓膜修补术治疗慢性化脓性中耳炎鼓膜穿孔的效果观察

Effect of endoscopic tympanic membrane repair on chronic suppurative otitis media with perforation of tympanic membrane

目的探讨耳内镜下鼓膜修补术治疗慢性化脓性中耳炎鼓膜穿孔患者的临床效果。方法选取台州市中心医院2014年11月至2018年9月治疗的慢性化脓性中耳炎鼓膜穿孔患者72例,按照治疗方法不同分为对照组与观察组各36例。对照组行显微镜下鼓膜修补术治疗,观察组行耳内镜下鼓膜修补术治疗。比较两组手术出血量和手术时间,采用数字模拟评分法(VAS)评价两组患者疼痛程度,记录两组术后住院时间及并发症,术后随访6个月评价两组手术切口美观情况,评价两组听力改善状况及治疗效果。结果观察组手术出血量为(6.14±1.25)mL,明显少于对照组的(19.87±2.65)mL,手术时间为(75.69±2.54)min,明显短于对照组的(102.34±3.69)min(t=28.116、35.694,均P<0.05)。观察组术后VAS评分为(2.34±0.62)分,明显低于对照组的(3.59±0.85)分(t=7.128,P<0.05)。观察组术后平均住院时间为(4.89±1.25)d,明显短于对照组的(9.18±1.36)d(t=13.935,P<0.05)。观察组术后切口满意度明显高于对照组(P<0.05)。观察组听力改善程度为(22.058±10.129)dB,与对照组的(21.695±9.764)dB比较,差异无统计学意义(P=0.487)。观察组治疗有效率为94.44%(34/36),对照组为91.67%(33/36)(χ^2=3.598,P=0.165);观察组并发症发生率为2.78%(1/36),明显低于对照组的16.67%(6/36)(χ^2=3.956,P=0.046)。结论慢性化脓性中耳炎鼓膜穿孔患者采用耳内镜下鼓膜修补术治疗效果更显著,且该手术方式术后美观性更好。

Objective To investigate the effect of endoscopic tympanic membrane repair in the clinical treatment of patients with chronic suppurative otitis media with tympanic membrane perforation. Methods From November 2014 to September 2018, 72 patients with chronic suppurative otitis media with tympanic membrane perforation in Taizhou Central Hospital were divided into control group and observation group according to different treatment methods, with 36 cases in each group.The control group underwent microsurgical tympanic membrane repair, the observation group underwent endoscopic tympanic membrane repair.The bleeding volume and operation time of the two groups were compared.The pain degrees of the two groups were evaluated by numerical simulation scale (VAS). The postoperative hospital stay and complications were recorded.The postoperative follow-up of 6 months was used to evaluate the aesthetics of the two groups.The hearing improvement status and treatment effect of the two groups were evaluated. Results The average surgical bleeding volume of the observation group was (6.14±1.25)mL, which was significantly less than that of the control group [(19.87±2.65)mL], and the operation time was (75.69±2.54)min, which was significantly shorter than that of the control group [(102.34±3.69)min](t=28.116, 35.694, all P<0.05). The VAS score of the observation group was (2.34±0.62)points, which was significantly lower than that of the control group [(3.59±0.85)points](t=7.128, P<0.05). The average length of hospital stay in the observation group was (4.89±1.25)d, which was significantly shorter than that in the control group [(9.18±1.36)d](t=13.935, P<0.05). The incision satisfaction of the observation group was significantly higher than that of the control group(P<0.05). The improvement in hearing of the observation group was (22.058±10.129)dB, which of the control group was (21.695±9.764)dB, the difference was not statistically significant (P=0.487). The effective rate of the observation group was 94.44%(34/36), which of the control group was 91.67%(33/36)(χ^2=3.598, P=0.165). The incidence rate of complications in the observation group was 2.78%(1/36), which was significantly lower than 16.67%(6/36) in the control group(χ^2=3.956, P=0.046). Conclusion Chronic suppurative otitis media tympanic membrane perforation patients treatment with endoscopic tympanic membrane repair is more effective, and the surgical method is better after surgery, so it is more acceptable to patients, it is worthy of promoting.