水下磨骨技术在中耳胆脂瘤经外耳道耳内镜手术中的应用

Application of underwater bone grinding technique in otoscopic surgery via external auditory meatus for middle ear cholesteatoma

目的探讨经外耳道耳内镜中耳胆脂瘤切除术中进行水下磨骨的方法,并比较水下磨骨与常规磨骨的差异。方法选择该院耳鼻咽喉科经外耳道耳内镜手术治疗的中耳胆脂瘤患者60例,其中水下磨骨组31例、常规磨骨组29例,评价两组患者手术时间、磨骨时间、术后听力恢复及手术并发症情况。结果水下磨骨组手术时间、磨骨时间均明显少于常规磨骨组(P<0.01);与术前比较,术后6个月两组患者术耳听力均明显改善(P<0.01);手术并发症主要是外耳道皮肤灼伤、鼓膜外耳道皮瓣损伤、鼓索损伤及耳屏切口相关并发症,水下磨骨组外耳道皮肤灼伤、鼓索损伤的发生少于常规磨骨组(P<0.05)。结论中耳胆脂瘤经外耳道耳内镜手术中采用水下磨骨技术能缩短手术时间提高手术效率,并减少手术相关并发症的发生。

Objective To explore the method of underwater bone grinding in otoscopic surgery via external auditory meatus for middle ear cholesteatoma,and to compare the difference between underwater bone grinding and conventional bone grinding.Methods Sixty patients with middle ear cholesteatoma treated by otoscopic surgery via external auditory meatus in the otorhinolaryngology department of this hospital were selected,including 31 cases in the underwater bone grinding group and 29 cases in the conventional bone grinding group.The surgical time,bone grinding time,postoperative hearing recovery and surgical complications were evaluated in the two groups.Results The surgical time and bone grinding time in the underwater bone grinding group were shorter than those in the conventional bone grinding group(P<0.01);in postoperative 6-month follow up,the hearing of the surgical ear in the two groups was improved compared with before operation(P<0.01);The surgical complications were mainly the skin burn of external auditory canal,injury of the tympanomeatal flap,injury of chorda tympani and the complications related to the incision of the tragus.The occurrence of the skin burn of external auditory canal and chorda tympani injury in the underwater bone grinding group were less than those in the conventional bone grinding group.Conclusion Adopting the underwater bone grinding technique in otoscopic surgery via external auditory meatus for middle ear cholesteatoma can shorten the surgical time,increase the operation efficiency and reduce the occurrence of surgical complications.