持续灌流与非灌流切换结合模式的耳内镜下中耳胆脂瘤手术

Endoscopic Middle Ear Cholesteatoma Surgery with Combined Alternating Continuous Irrigation and Non-Irrigating Modes

目的本文旨在探索持续灌流模式在耳内镜手术中应用的最佳方式,以及尝试建立持续灌流与非灌流模式切换结合的耳内镜中耳胆脂瘤手术流程。方法回顾性分析在2019年1月至2020年12月间收治的73名单侧的中耳胆脂瘤患者,术中确定为中上鼓室胆脂瘤患者,年龄为10-68岁,其中女性患者34名,男性患者39名。其中33名患者采用持续灌流与非灌流模式切换结合的耳内镜中耳手术方式,40名患者采用常规非灌流模式下的耳内镜中耳手术方式。所有患者手术中均为同一术者全程在耳内镜方式下完成。持续灌流与非灌流模式切换结合的耳内镜中耳胆脂瘤手术,自切口开始就在灌流模式下进行,除非鼓室内侧壁出血广泛影响手术视野外,探查和磨骨、清除病变的手术程序均要在水下进行,鼓室成形,听骨链重建和上鼓室外侧壁重建在非灌流模式下进行。结果两组患者平均年龄及术前听力无统计学差异,且两组患者病变范围、程度均无明显偏差。回顾性研究中,所有符合标准的病历均入选,无人为偏倚。33名采用持续灌流与非灌流模式切换结合的耳内镜中耳胆脂瘤手术患者平均手术用时86.52±7.30分钟;其中只有一名患者由于耳道皮瓣在灌流模式下漂浮影响,术中将耳道皮瓣连同鼓膜取出后,完成后续手术外,其余32个病例均保持耳道皮瓣原位固定后完成手术。40名采用常规非灌流模式下的耳内镜中耳手术患者平均手术用时117.15±9.34分钟。两种手术模式用时比较后具有统计学差异。结论耳内镜下持续灌流手术方式的引入,在一定程度上有助于解决术中切口止血,更为重要的应用在于术中磨骨骨质上的应用。若合理规划手术流程,将持续灌流与非灌流模式相结合,在手术中便捷地随时切换,可以极大地简化了手术流程,缩短手术时间,在临床实践中值得推介。

Objective The purpose of this paper is to determine optimal use of continuous irrigation in endoscopic ear surgery and establish a.surgical protocol with combined alternating continuous irrigation and non-irrigating mode for endoscopic resection of middle ear cholesteatoma.Methods Data from 73 patients(34 females and 39 males,aged 10-68 years)with unilateral upper/upper and middle tympanic middle ear cholesteatoma admitted between January 2019 and December 2020 were retrospectively analyzed.Combined alternating continuous irrigation/non-irrigating mode was used during endoscopic middle ear surgery in 33 patients,and conventional non-irrigating mode was used in 40 patients.All the operations were performed by the same surgeon.In the combined continuous irrigation/non-irrigating technique,continuous irrigation was used from skin incision,unless bleeding from medial wall of the tympanum affected vision,and throughout exposure,exploration,bone and lesion removal,while tympanoplasty including ossicular chain reconstruction and reconstruction of epitympanum wall were performed in a non-irrigating mode.Results There was no significant difference in average age,preoperative hearing levels and the scope and severity of lesions between the two groups.All eligible medical records were included in retrospective analysis,with no selection bias.The average operation time was 86.52±7.30 min in the 33 patients in whom combined continuous irrigation and non-irrigating modes were used,and 117.15±9.34 min in the 40 patients in whom the conventional non-irrigating mode was used.In one patient,the floating ear canal flap affected visualization under continuous irrigation and was removed together with the tympanic membrane to complete the surgery.The ear canal flap was kept in place in the 32 cases.Conclusion To a certain extent,continuous irrigation operation helps incision hemostasis during endoscopic ear surgery,and more importantly facilitates bone removal.When adequately planned and employed,continuous irrigation and non-irrigating mode can be combined and conveniently alternated when needed,which can greatly simplify the operation process and shorten operation time.The technique may be worth adopting in clinical practice.