耳内镜下人工镫骨手术在耳硬化症治疗中的应用价值

Value of endoscopic stapedotomy in the treatment for otosclerosis

目的探讨耳内镜下人工蹬骨手术在耳硬化症治疗中的临床应用价值。方法回顾性分析2017年12月—2019年12月安徽医科大学第一附属医院耳鼻咽喉头颈外科22例耳硬化症患者的临床资料,其中男9例、女13例,年龄13~70(33.4±11.2)岁。患者均在耳内镜下行人工镫骨手术。术后观察患者眩晕、面瘫及味觉障碍等术后并发症发生情况,术后2周观察外耳道及鼓膜愈合情况,比较术前与术后3个月纯音测听0.5、1、2、4 KHz时的气导阈值、骨导阈值及气导、骨导阈值差值的差异。结果22例耳硬化患者均顺利在耳内镜下完成人工镫骨手术,手术时间50~145(79.5±29.2)min。术后3例出现味觉障碍,3个月内自行缓解;5例出现术后轻度眩晕予相应处理后治愈;无面瘫、感音神经性耳聋的发生。22例患者均获随访,随访时间4个月~2年,平均14.5个月。术后2周复查,术耳外耳道切口愈合佳,无外耳道狭窄,无鼓膜穿孔。术后3个月复查听力,气导阈值和气导、骨导阈值差值分别为(34.1±14.3)和(11.5±7.8)dBHL,较术前的(58.5±13.3)、(34.8±10.4)dBHL均明显降低,差异均有统计学意义(t=5.860、8.407,P值均<0.01);术后骨导阈值(22.6±10.4)dBHL,与术前的(23.7±8.3)dBHL比较,差异无统计学意义(P>0.05)。术后随访期间无一例患者需行翻修手术。结论耳内镜下人工镫骨手术治疗耳硬化症,具有创伤小、术中暴露范围广、视野清晰、术后并发症发生率低等优势,术后患者听力可明显改善,是一种有效可行的手术方法。

Objective To explore the value of endoscopic stapedotomy for treating otosclerosis patients.Methods The medical records of 22 patients who underwent endoscopic stapedotomy in the First Affiliated Hospital of Anhui Medical University between December 2017 and December 2019 were retrospectively analyzed.Patients included 9 males and 13 females,aged 13-70(33.4±11.2)years old.The intraoperative situation and postoperative complications of the patients were reported.Postoperative complications such as vertigo,facial paralysis,and taste impairment were observed.The healing of the external auditory canal and tympanic membrane was observed 2 weeks after the operation.The mean preoperative and postoperative(3 months after operation)pure tone air conduction,bone conduction threshold,and air-bone gap of 0.5,1,2 and 4 KHz were compared to evaluate the audiological effect.Results Twenty-two patients with otosclerosis successfully underwent endoscopic stapedotomy for 50-145(79.5±29.2)min.No cases of facial paralysis or sensorineural deafness were reported.Three cases of dysgeusia after the operation were relieved within 3 months,and five cases of dizziness were treated with medications.All cases were followed up for 4 months to 2 years,with an average of 14.5 months.The external ear canal incision healed well,with no external ear canal stenosis and no tympanic membrane perforation,two weeks after the operation.Postoperative hearing was evaluated 3 months after surgery.The air conduction threshold and air-bone gap were significantly reduced to(34.1±14.3),(11.5±7.8)dBHL,respectively.The differences were statistically significant(t=5.860,8.407,all P values<0.01)compared with the preoperative(58.5±13.3),(34.8±10.4)dBHL.The difference between the postoperative bone conduction threshold(22.6±10.4)dBHL and the preoperative(23.7±8.3)dBHL was not statistically significant(P>0.05).No patients underwent revision surgery during follow-up.Conclusions Endoscopic stapedotomy for treating otosclerosis is an effective and feasible operation method,with the advantages of less trauma,wide and clear intraoperative exposure,low postoperative complication rate,and remarkable audiological effect.