耳内镜与显微镜下鼓膜成形术的术中术后效果对比

Comparative analysis of the intraoperative and post-operative effects of otoendoscopic and microscopic tympanoplasty

目的比较耳内镜下鼓膜成形术及显微镜下鼓膜成形术治疗因中耳炎引起鼓膜穿孔患者的术中术后各项指标变化及安全性。方法选取2016年1月-2018年6月该院收治的鼓膜穿孔患者74例,分为耳内镜组(n=37)和显微镜组(n=37),耳内镜组行耳内镜下鼓膜成形术治疗,显微镜组行显微镜下鼓膜成形术治疗。观察两组患者手术相关指标、术后鼓膜愈合、听力改善和并发症发生情况等。结果耳内镜组40~50 min和50~60 min手术完成率均明显高于显微镜组(χ2=5.05和22.42,P <0.05),平均手术时间较显微镜组短(t=7.88,P <0.05),术中平均出血量较显微镜组少(t=17.21,P <0.05),术后住院时间明显较显微镜组短(t=9.37,P <0.05);耳内镜组术后24 h视觉模拟评分(VAS)明显低于显微镜组(t=25.00,P <0.05);两组患者术后1、6和12个月鼓膜愈合率比较,差异均无统计学意义(χ2=0.21、0.16和0.13,P> 0.05);两组术后平均气导听阈和气骨导差均明显低于术前(P <0.05),但组间比较,差异无统计学意义(P> 0.05);耳内镜组术后并发症总发生率为2.70%,明显低于显微镜组16.22%(χ2=3.94,P <0.05)。结论显微镜和耳内镜下鼓膜成形术用于中耳炎所致鼓膜穿孔治疗,均可使患者听力得到有效改善,但耳内镜下鼓膜成形术更省时、出血更少、术后疼痛程度更轻,可明显降低术后并发症发生率。

Objective To evaluate the changes and safety of various indicators of patient with tympanic membrane perforation during and after otoendoscopic and microscopic tympanoplasty.Methods 74 patients with tympanic membrane perforation from January 2016 to June 2018 were divided into two groups,otoendoscopy group(n=37)was treated with tympanoplasty under ear endoscope,microscopic group(n=37)was treated with tympanoplasty under microscopy.Relevant surgical indicators,tympanic membrane healing,hearing improvement and complications were observed.Results Compared with the microscopic group,the completion rate of otoendoscopy group was significantly higher in 40~50 min and 50~60 min,the average operation time was significantly shorter,the average bleeding volume was significantly less,and the hospital stay was significantly shorter after operation(χ2=5.05,22.42,t=7.88,17.21,9.37,P<0.05);VAS score at 24 h after operation in otoendoscopy group was significantly lower than that in microscopy group(t=25.00,P<0.05);There was no significant difference in the healing rate of tympanic membrane between the two groups at 1,6 and 12 months after operation(χ2=0.21,0.16,0.13,P>0.05);The average air conduction hearing threshold and air-bone conduction difference of the two groups after operation were significantly lower than those before operation(P<0.05),but there was no significant difference between the two groups(P>0.05);The total incidence of postoperative complications in otoendoscopy group was 2.70%,which was significantly lower than that in microscopy group(16.22%)(χ2=3.94,P<0.05).Conclusion Myringoplasty under microscopy and otoendoscopy is used to treat tympanic membrane perforation caused by otitis media,compare with otoendoscopic tympanoplasty,tympanoplasty is more time-saving,less bleeding,less pain,and can significantly reduce postoperative complications.