自体全厚耳屏软骨-软骨膜复合体与耳屏软骨膜修补穿孔鼓膜的临床疗效及安全性分析

Analysis of clinical efficacy and safety of autologous full-thickness tragus cartilage-perichondrium complex and tragus perichondrium in repairing perforated tympanic membrane

目的:探讨自体全厚耳屏软骨-软骨膜复合体与耳屏软骨膜修补穿孔鼓膜的临床疗效和安全性。方法:按修补方式不同将138例鼓膜穿孔患者分为全厚软骨组(n=68,耳数=95)和软骨膜组(n=70,耳数=100),全厚软骨组患者使用自体全厚耳屏软骨-软骨膜复合体进行穿孔鼓膜修补手术,软骨膜组患者使用耳屏软骨膜进行穿孔鼓膜修补手术。比较两组患者围术期指标(手术时间、术中出血量、耳屏愈合时间)、鼓膜愈合率。比较两组患者术前和术后3个月的听力水平(骨导听阈、气导听阈、气骨导差)、耳鸣情况及手术后3个月内手术并发症总发生率。结果:软骨膜组患者手术时间、术中出血量、耳屏愈合时间[(38.96±9.13)min、(6.12±1.30)mL、(4.96±0.58)d]均小于全厚软骨组[(43.71±9.85)min、(8.67±1.74)mL、(5.22±0.61)d],差异有统计学意义(P<0.05);鼓膜愈合率高于全厚软骨组(98.00%vs.90.53%,P=0.024)。术后3个月,两组患者气导听阈、气骨导差和耳鸣致残量表(THI)评分小于术前(P<0.05),骨导听阈高于术前(P<0.05),但组间比较差异均无统计学意义(P>0.057)。术后3个月内,软骨膜组患者并发症总发生率低于全厚软骨组(P<0.05)。结论:耳屏软骨膜与自体全厚耳屏软骨-软骨复合体用于修补穿孔鼓膜,二者改善患者听力和耳鸣效果相近,但耳屏软骨膜修补穿孔鼓膜手术难度较低,手术创伤较少,术后并发症发生风险较低,安全性高。

Objective:To study the clinical efficacy and safety of autologous full-thickness tragus cartilage-perichondrium complex and tragus perichondrium in repairing perforated tympanic membrane.Methods:138 patients with tympanic membrane perforation were taken as the research subjects,and they were divided into full-thickness cartilage group(n=68,the number of ears=95)and perichondrium group(n=70,the number of ears=100)according to different repair methods.The patients in the full-thickness cartilage group applied autologous full-thickness tragus cartilage-perichondrium complex for perforated tympanic membrane repair,and the patients in the perichondrium group adopted tragus perichondrium for perforated tympanic membrane repair.The perioperative indicators[surgical time,intraoperative blood loss,tragus healing time],tympanic membrane healing rate,hearing level[bone conduction hearing threshold,air conduction hearing threshold,air-bone gap]and tinnitus status before surgery and at 3 months after surgery and total incidence rate of surgical complications within 3 months after surgery were compared between the two groups of patients.Results:The surgical time,intraoperative blood loss and tragus healing time of[(38.96±9.13)min,(6.12±1.30)ml,(4.96±0.58)d]in perichondrium group were significantly shorter or less than[(43.71±9.85)min,(8.67±1.74)ml,(5.22±0.61)d]in full-thickness cartilage group,the differents were statistically significant(P<0.05).The healing rate of tympanic membrane was significantly higher than that in full-thickness cartilage group(98.00%vs.90.53%,P=0.024).At 3 months after surgery,the air conduction hearing threshold,air-bone gap and tinnitus handicap inventory(THI)score of the two groups were obviously lower than those before surgery(P<0.05),while the bone conduction hearing threshold was obviously higher than that before surgery(P<0.05),but the differences between the two groups were not significant(P>0.057).The total incidence of complications was significantly lower in perichondrium group than that in full-thickness cartilage group within 3 months after surgery(P<0.05).Conclusion:Tragus perichondrium and autologous full-thickness tragus cartilage-perichondrium complex to repair perforated tympanic membrane both have similar effects in improving hearing and tinnitus,but the former one can has lower surgical difficulty,less surgical trauma,lower risk of postoperative complications and better safety.