摘要
目的探讨耳内镜下鼓室探查和鼓室成形术治疗中耳常见病变的可行性及疗效。方法30例耳漏伴听力下降患者,包括慢性单纯性中耳炎12例、粘连性中耳炎5例、鼓室硬化6例、中耳胆脂瘤7例。均行耳内镜下鼓室探查+鼓室成形术,根据病变情况行病变清除、外耳道重建、听骨链重建、鼓膜成形等。观察患者鼓膜愈合率、干耳率、听力效果等。结果 28例患者鼓膜修复良好,愈合率93.3%,2例遗留小穿孔,经搔刮穿孔边缘后愈合,均达到干耳。术前平均气导(52.41±19.89)dB,术后(38.11±18.36)dB,差异有统计学意义(t =9.221,P =0.000);术前平均骨导(19.93±16.31)dB,术后(20.21±16.22)dB,差异无统计学意义(t =-2.623,P =0.014);术前平均气骨导差(32.49±10.74)dB,术后(17.81±9.42)dB,差异有统计学意义(t =9.730,P =0.000)。对不同疾病分组,各组间术前的平均气导、骨导及气骨导差之间比较,差异均无统计学意义。各组间术后平均气导、骨导及气骨导差之间比较,差异均无统计学意义。30例患者保留鼓索神经21例,占70%;术后面瘫0例;术后眩晕3例,均为轻度;术后骨导明显提高者0例。结论 耳内镜手术适应证广,适应于各种中耳疾病,总体效果满意。耳内镜下手术具有微创、美观等特点,去除骨质较少,易于重建修复。耳内镜下外耳道、中耳手术具有良好的安全性及有效性,值得推广。
OBJECTIVE To investigate thefeasibility and efficacy of tympanoplasty combined with tympanoscopy in the treatment of common diseases of the middle ear. METHODS Thirty patients with otorrhea and hearing loss were included, including 12 cases of chronic otitis media, 5 cases of adhesive otitis media, 6 cases of tympanosclerosis and 7 cases of cholesteatoma of the middle ear. All patients underwent tympanoplasty plus tympanoplasty under otoendoscopy. According to the pathological changes, removal of lesions, reconstruction of external auditory canal, reconstruction of ossicular chain and tympanoplasty were performed. The healing rate of tympanic membrane, dry ear rate and hearing effect were observed. RESULTS The healing rate of tympanic membrane was 93.3%. Preoperative pneumatic conduction(52.41±19.89)dB and postoperative pneumatic conduction(38.11±18.36)dB had significant difference(t=9.221, P=0.000);preoperative bone conduction(19.93±16.31)dB and postoperative bone conduction(20.21±16.22)dB had no significant difference(t=-2.623, P=0.014);preoperative pneumatic-bone conduction difference(32.49±10.74)d B and postoperatively(17.81±9.42)dB had significant difference(t=9.730, P=0.000). There was no significant difference in air conduction, bone conduction and air-bone conduction before operation among different diseases, and there was no significant difference in air conduction, bone conduction and air-bone conduction after operation. Complications preservation rate of tympanic nerve was 70%. Facial paralysis was 0 case. Mild vertigo was 10%. Bone conduction was significantly improved in 0 case. CONCLUSION Endoscopic ear surgery is suitable for various middle ear diseases, and the overall effect is satisfactory. Endoscopic ear surgery has the characteristics of minimally invasive and beautiful. Endoscopic ear surgery has good safety and effectiveness.
作者
钟晓声
范绍翀
杨海弟
ZHONG Xiaosheng;FAN Shaochong;YANG Haidi(Department of Otolaryngology,Zengcheng People's Hospital,Guangzhou,Guangdong,511300,China;Department of Otolaryngology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou,Guangdong,510120,China)
出处
《中国耳鼻咽喉头颈外科》
CSCD
2019年第7期354-357,共4页
Chinese Archives of Otolaryngology-Head and Neck Surgery
基金
广东省科技创新战略专项资金（科技基础条件建设领域）第一批项目资金资助（2018A030321007)
关键词
耳外科手术
内窥镜检查
胆脂瘤
中耳
鼓室成形术
Otologic Surgical Procedures
Endoscopy
Cholesteatoma, Middle Ear
Tympanoplasty
