显微镜与耳内镜下鼓膜修补术治疗鼓膜穿孔的效果比较

Efficacy of microscopic myringoplasty versus endoscopic myringoplasty in the treatment of tympanic membrane perforation

目的比较显微镜与耳内镜下鼓膜修补术治疗慢性化脓性中耳炎鼓膜穿孔的临床效果。方法回顾性分析嘉兴市第二医院2017年2月至2019年3月收治的慢性化脓性中耳炎鼓膜穿孔患者91例的临床资料,根据手术方法分为对照组45例、观察组46例,对照组采用显微镜下鼓膜修补术治疗,观察组采用耳内镜下鼓膜修补术治疗,比较两组手术效果。结果观察组手术出血量[(7.2±2.0)mL]明显少于对照组[(13.7±3.1)mL]、手术时间[(59.4±5.4)min]短于对照组[(91.5±11.2)min]、术后疼痛评分[(2.9±0.7)分]低于对照组[(4.8±1.3)分]、住院时间[(4.3±1.0)d]短于对照组[(6.5±1.5)d],差异均有统计学意义(t=11.912、17.474、8.707、8.249,均P<0.001);观察组1 kHz、2 kHz、4 kHz测量频率下纯音听阈值均高于对照组(均P<0.05);观察组患者对手术切口美观效果的满意度为97.8%(45/46),明显高于对照组的77.8%(35/45),差异有统计学意义(χ^(2)=8.604,P=0.003)。结论与显微镜下鼓膜修补术相比,耳内镜下鼓膜修补术治疗慢性化脓性中耳炎鼓膜穿孔具有手术时间短、出血量少、疼痛程度轻等优势,患者听力改善明显且满意度高。

Objective To investigate the clinical efficacy of microscopic myringoplasty versus endoscopic myringoplasty in the treatment of tympanic membrane perforation caused by chronic suppurative otitis media.Methods The clinical data of 91 patients with tympanic membrane perforation caused by chronic suppurative otitis media who received treatment in Jiaxing Second Hospital,China between February 2017 and March 2019 were retrospectively analyzed.These patients were divided into a control group(n=45)and an observation group(n=46)according to different surgery methods.The control group was given microscopic tympanoplasty,while the observation group was given endoscopic tympanoplasty under the otoendoscope.Results Blood loss in the observation group was significantly lower than that in the control group[(7.2±2.0)mL vs.(13.7±3.1)mL,t=11.912,P<0.001].Operation time in the observation group was significantly shorter than that in the control group[(59.4±5.4)min vs.(91.5±11.2)min,t=17.474,P<0.001].Postoperative pain score in the observation group was significantly lower than that in the control group[(2.9±0.7)points vs.(4.8±1.3)points,t=8.707,P<0.001].Hospital stay in the observation group was significantly shorter than that in the control group[(4.3±1.0)d vs.(6.5±1.5)d,t=8.249,P<0.001].Pure tone hearing thresholds at 1,2 and 4 kHz frequencies in the observation group were significantly higher than those in the control group(all P<0.05).Patient satisfaction regarding the aesthetic effect of the surgical incision in the observation group was significantly higher than that in the control group[97.8%(45/46)vs.77.8%(35/45),χ^(2)=8.604,P=0.003].Conclusion Endoscopic myringoplasty has the advantages including shorter operation time,less blood loss,lower degree of pain,better hearing improvement and higher patient satisfaction over microscopic myringoplasty in the treatment of tympanic membrane perforation caused by chronic suppurative otitis media.