持续灌流耳内镜模式下经外耳道切口Ⅰ型鼓室成形术疗效分析

Study on the effect of tympanoplasty I via external auditory canal incision under otoscope with continuous perfusion

目的 探讨采用持续灌流耳内镜手术模式Ⅰ型鼓室成形术治疗鼓膜大穿孔患者的临床效果。方法 回顾性分析住院患者分别在持续灌流模式(观察组33例)及非持续灌流模式(对照组31例)耳内镜下采用外耳道切口进行Ⅰ型鼓室成形术患者临床资料,观察分析手术时间、鼓膜愈合成功率,比较2组术前及术后6个月平均气、骨导听阈及气导听阈差。结果 2组患者术后鼓膜均一期愈合。观察组平均手术时间为(58.73±6.07)min,对照组为(66.29±8.27)min,观察组手术时间低于对照组(P<0.05)。观察组术后6个月后平均气导听阈与对照组比较差异无统计学意义(P>0.05);术后6个月平均骨导听阈2组比较,差异无统计学意义(P>0.05)。术后并发症:观察组术后出现耳鸣1例;对照组术后味觉改变3例,耳鸣2例,眩晕2例,对照组术后并发症发生率高于观察组(P<0.05)。结论 持续灌流耳内镜手术模式可以极大改善耳内镜手术中镜头散热、镜头起雾、手术中出血污染镜头等,提高了手术连贯性及安全性。

Objective To study the clinical effect of tympanoplasty Ⅰ via external auditory canal incision under otoscope with continuous perfusion in the treatment of large perforation of tympanic membrane.Methods The clinical data of inpatients who underwent tympanoplasty Ⅰ with external auditory canal incision under the continuous perfusion mode( 33 cases in the observation group) and the noncontinuous perfusion mode( 31 cases in the control group) were analyzed retrospectively. The operation time and the success rate of tympanic membrane healing were observed and analyzed. The air and bone conducted auditory thresholds and air bone gap were compared between the two groups before the operation and 6 months after the operation.Results The tympanic membrane of the two group completely healed after operation. The average operation time was(58.73±6.07)min in the observation group and that in the control group was(66.29±8.27)min.The operation time in the observation group was lower than that in the control group(P<0.05). There was no significant difference in the mean air conducted auditory thresholds between the two groups 6 months after surgery. There was no significant difference in the average bone condition hearing threshold between the observation group and the control group after 6 months(P>0.05). The postoperative complications: 1 case of tinnitus was occurred in the observation group, There were 3 cases of taste change, 2 cases of tinnitus and 2 cases of vertigo in the control group after operation. The incidence of postoperative complications in the control group was higher than that in the observation group(P<0.05).Conclusion The auricular endoscopic surgery with continuous perfusion can greatly improve lens heat dissipation, lens fogging, and lens contamination during surgery, and improve the surgical continuity and safety.