摘要
目的:探讨耳内镜下蝶形软骨嵌入法与耳屏软骨膜内置法修补鼓膜中等穿孔的临床效果及其差别。方法:回顾性分析2021年6月至12月在宁波市第二医院耳鼻咽喉科住院接受耳内镜下不翻瓣鼓室成形术I型的鼓膜中等穿孔患者临床资料。根据手术方式分为两组,其中观察组采用蝶形软骨嵌入法修补鼓膜穿孔,对照组采用耳屏软骨膜内置法修补鼓膜穿孔。两组术后6、12、18个月定期随访,并行耳内镜、纯音听阈检查。比较两组术后鼓膜穿孔愈合、听力恢复、并发症、耳闷感及手术时间等情况。结果:纳入研究病例56例,其中观察组32例,对照组24例。两组在性别、年龄、鼓膜穿孔病因、位置、鼓膜钙化斑、干湿耳方面差异无统计学意义(均P>0.05)。术后6、12个月两组鼓膜穿孔愈合率均为100%。术后18个月观察组鼓膜穿孔愈合30例(93.75%),对照组22例(91.67%),差异无统计学意义(P>0.05)。观察组平均气导由术前(35.29±7.25)dB HL下降至术后18个月(19.06±4.96)dB HL(t=27.848,P<0.01),平均气骨导差由术前(16.72±4.95)dB HL下降至术后18个月(7.66±3.37)dB HL(t=18.166,P<0.01)。对照组平均气导由术前(33.23±5.71)dB HL下降至术后18个月(17.76±2.55)dB HL(t=20.276,P<0.01),平均气骨导差由术前(15.36±4.73)d B HL下降至术后18个月(7.45±2.67)dB HL(t=16.108,P<0.01)。两组平均气导下降程度及平均气骨导下降程度比较,差异均无统计学意义(t=0.804,P=0.425;t=1.599,P=0.116)。观察组手术时间为(27.72±3.03)min,明显短于对照组(31.71±3.95)min,观察组术后耳闷感VAS评分为(2.09±0.69),明显低于对照组(3.42±0.72),差异均有统计学意义(t=-8.949,P<0.01;t=-6.987,P<0.01)。结论:耳内镜下蝶形软骨嵌入法修补鼓膜中等穿孔的临床效果与耳屏软骨膜内置法均良好,成功率高、并发症少,较耳屏软骨膜内置法耗时短、术后耳闷感轻。
Objective:To investigate the clinical effect of inlay butterfly cartilage and underlay tragus perichondriummyringoplasty on moderate tympanic membrane perforation under endoscope and the differences between them.Methods:The clinical data of patients from the department of Otolaryngology of Ningbo No.2 Hospital with moderate tympanic membrane perforation form June to December 2021,who underwent endoscopic tympanoplasty without tympanomeatal flap elevation,were retrospectively analyzed.According to the operation method,the patients were dividedinto two groups:the observation group used inlay butterfly cartilage myringoplasty,and the control group used underlay tragus perichondrium myringoplasty.The two groups were followed up regularly at 6,12 and 18 months postoperatively,with otoscopy and pure tone audiometry(PTA) performed.The graft success rate,hearing outcomes,complications,ear fullness and operation time were compared between the two groups.Results:Of 56 cases included in the study,32 cases were in the observation group and 24 cases in the control group.There was no significant difference in sex,age,cause and location of tympanic membrane perforation,calcified spot and dry and wet ears between the two groups(P>0.05).The graft success rate in both groups was 100.00% at 6 and 12 months postoperatively.At 18 months postoperatively,graft success rate was 93.75%(30/32) in the observation group and 91.67%(22/24) in the control group.There was no significant difference between two groups(P>0.05).In the observation group,the mean PTA decreased from(35.29±7.25) dB HL preoperatively to(19.06±4.96) dB HL at 18 months postoperatively,and the mean air-bone gaps(ABG)decreased from(16.72± 4.95) dB HL preoperatively to(7.66±3.37) dB HL at 18 months postoperatively.In the control group,the mean PTA decreased from(33.23±5.71) dB HL preoperatively to(17.76±2.55) dB HL at 18 months postoperatively,and the mean ABG from(15.36±4.73) dB HL preoperatively to(7.45±2.67) dB HL at 18 months postoperatively.There was no significant difference in the decreasing degree of mean PTA and ABG between two groups(P>0.05).The operation time of the observation group was significantly shorter than that of the control group [(27.72±3.03) vs.(31.71±3.95) min].The VAS score of postoperative ear fullness in the observation group was significantly lower than that of the control group(P<0.01).Conclusion:Endoscopic inlay butterfly cartilage myringoplasty and underlay tragus perichondrium myringoplasty both have good clinical effect on moderate tympanic membrane perforation with high success rate and less complications,however,the former takes less time and leads to less postoperative fullness.
作者
张露
张祥宝
杨焕焕
潘芳芳
吴诗媛
徐超
余啸
王凯
ZHANG Lu;ZHANG Xiangbao;YANG Huanhuan;PAN Fangfang;WU Shiyuan;XU Chao;YU Xiao;WANG Kai(Department of Otolaryngology,Ningbo No.2 Hospital,Ningbo 315000,China)
出处
《温州医科大学学报》
CAS
2024年第1期14-19,共6页
Journal of Wenzhou Medical University
基金
浙江省医药卫生科技计划项目(2022ZH049)
宁波市第二医院华美研究基金项目(2023HMKY13)。
关键词
鼓膜穿孔
鼓膜成形术
蝶形软骨
嵌入法
内窥镜
tympanic membrane perforation
myringoplasty
butterfly cartilage
inlay
endoscope
