耳内镜与耳显微镜下鼓膜成形术对慢性化脓性中耳炎患者听力改善率及临床疗效的影响

Study on the effect of otoendoscopic and otomicroscopic tympanoplasty on rate of hearing improvement and clinical efficacy in patients with chronic suppurative otitis media

目的比较耳内镜与耳显微镜下鼓膜成形术治疗慢性化脓性中耳炎患者的听力改善率及临床疗效。方法前瞻性选取2015年1月至2017年12月重庆市开州区人民医院收治的60例慢性化脓性中耳炎患者。采用随机数字表法,将患者分为对照组(n=30)和观察组(n=30),对照组患者给予耳显微镜下鼓膜成形术,观察组患者给予耳内镜下鼓膜成形术。比较两组患者的围手术期情况、临床疗效、切口满意度和听力改善率等。结果观察组患者的术中出血量为(8. 57±1. 39) m L、手术时间为(53. 61±5. 58) min、视觉模拟评分(VAS)为(2. 36±0. 51)分,住院时间为(4. 14±0. 53) d,均低于对照组(P <0. 05)。观察组患者总有效率为96. 67%(29/30),对照组患者总有效率为80. 00%(24/30),差异具有统计学意义(P <0. 05)。观察组患者切口总满意率为93. 33%(28/30),对照组患者切口总满意率为73. 33%(22/30),差异具有统计学意义(P <0. 05)。观察组听力改善29例(96. 67%),对照组听力改善24例(80. 00%),差异具有统计学意义(P <0. 05)。观察组不良反应发生率为6. 67%(2/30),对照组不良反应发生率为10. 00%(3/30),差异无统计学意义(P> 0. 05)。结论与耳显微镜下鼓膜成形术相比,耳内镜下鼓膜成形术具有手术时间短、术中出血量少、术后疼痛轻、术后恢复快等优点,临床疗效显著,患者听力改善率和切口满意率更高,值得在临床推广应用。

Objective To study the effect of ear endoscopy and ear microscopic tympanoplasty on the rate of hearing improvement and clinical efficacy of patients with chronic suppurative otitis media.Methods This is a prospective study,60 cases of chronic suppurative otitis media treated in this hospital during January 2015 to December 2017 were selected.They were divided into control group(n=30)and observation group(n=30)by random number table method.Patients in control group were given with ear microscopic tympanic membrane plasty,and patients in observation group were given with ear endoscopic tympanoplasty.The perioperative condition,clinical efficacy,satisfaction in incision and hearing improvement rate were compared between these two groups.Results The amount of bleeding during operation,operating time,visual analogue scores(VAS)and duration for hospitalization were(8.57±1.39)ml,(53.61±5.58)min,(2.36±0.51)scores and(4.14±0.53)d respectively in observation group were lower than those of control group(P<0.05).The total effective rate was 96.67%(29/30)in observation group and 80.00%(24/30)in control group,and the difference had statistical significance(P<0.05).The total satisfactory rate of observation group was 93.33%(28/30),and that of control group was 73.33%(22/30),and the difference had statistical significance(P<0.05).There were 29 cases(96.67%)with hearing improvement in observation group and 24 cases(80.00%)in control group,and the difference had statistical significance(P<0.05).The incidence of adverse reactions was 6.67%(2/30)in observation group and 10.00%(3/30)in control group,but the difference had no statistical significance(P>0.05).Conclusion In comparison with ear microscopic tympanoplasty,ear endoscopic tympanoplasty has the advantages of short operating time,less intraoperative bleeding,less postoperative pain and quick recovery after operation.The clinical curative effect is remarkable,the rate of hearing improvement and the satisfaction of incision are higher.It is worthy to be applied in clinical practice.