耳内镜与显微镜在镫骨手术中的应用分析

The application of endoscope and microscope in the stapes surgeries

目的:比较耳内镜和显微镜在各种类型的镫骨手术中的应用特点。方法:分析2020年4月—2023年5月在解放军总医院第六医学中心耳鼻咽喉头颈外科完成的镫骨手术共59台次。通过统计学分析比较耳内镜组与显微镜组在术后听力、术后住院时间、换药次数等方面有无区别。分析因面神经遮窗不能植入人工镫骨的病例,比较2种手术方式的优缺点。结果:2组患者以耳硬化症为主,其中耳内镜组有1耳(1/23)为中耳畸形,显微镜组有5耳为中耳畸形(5/36),还有2耳为Van Der Hover综合征和4耳为Treacher Collins综合征。耳内镜组10耳(43.5%)术后气骨导差(ABG)≤10 dB,21耳(91.3%)术后ABG≤20 dB。显微镜组13耳(41.9%)术后ABG≤10 dB,28耳(90.3%)术后ABG≤20 dB,2组差异无统计学意义(P>0.05)。耳内镜组术后的复查次数较显微镜组少(P<0.01)。所有患者术后均未出现面瘫、鼓膜穿孔,未出现重度感音神经性听力下降。结论:对于术前评估镫骨畸形不严重、术中磨骨不多的患者,耳内镜手术较显微镜手术更具有优势,可以减少患者的术后复查次数。对于外耳道狭窄、中耳畸形程度较重的患者,显微镜提供的双手操作环境更利于手术顺利进行。

Objective:To compare the application of endoscope and microscope in all kinds of stapes surgeries.Methods:Fifty-nine stapes surgeries have been collected from April 2020 to May 2023 in Senior Department of Otolaryngology Head and Neck Surgery,Chinese PLA General Hospital,Chinese PLA Medical School.Hearing level,hospital stay post-operation,times of hospital visit post-operation,etc.have been compared between the endoscopic group and microscopic group.Patients who were failed to place the stapes prosthesis because of the poor exposure of the oval window have been analyzed.Results:Otosclerosis was the most common diagnosis in both groups.There was 1(1/23) middle ear malformation in the endoscopic group and 5(5/36) middle ear malformations in the microscopic group.There were 2 Van Der Hover syndromes and 4 Treacher Collins syndromes in the microscopic group.In the endoscopic group ABG of 10 ears(43.5%) ≤ 10 dB,and ABG of 21 ears(91.3%) ≤20 dB.In the microscopic group ABG of 13 ears(41.9%) ≤ 10 dB,and ABG of 28 ears(90.3%) ≤ 20 dB.There was no statistic difference between 2 groups.Times of hospital visit post-operation in the endoscopic group was less than in the microscopic group(P<0.01).There was no facial palsy,tympanic perforation or profound sensorineural hearing loss in both groups.Conclusion:Endoscope is more suitable for patients who are evaluated with no severe stapes malformation,or less manipulation of drilling the bone.It could also reduce the hospital visit post-operation.Patients with narrow ear canal or severe middle ear malformation are recommended to perform the surgery with microscope,because it provides the chance of manipulation with 2-hands of surgeons.