耳内镜下软骨膜-软骨岛与颞肌筋膜修补鼓膜穿孔的临床对照研究

Clinical comparative study in the endoscopic repair of tympanic membrane perforation with perichondrium-cartilage island and temporal muscle fascia

摘要:

目的 对比耳内镜下耳屏软骨膜-软骨岛与颞肌筋膜修补鼓膜穿孔的临床效果。方法 分析2018年2月-2020年3月徐州市中心医院行耳内镜修补鼓膜穿孔80例患者的临床资料，按修补材料不同分为两组，其中对照组（颞肌筋膜修补组）患者40例，试验组（耳屏软骨膜-软骨岛修补组）40例。比较两组患者术中出血量、手术时间、住院时间和鼓膜穿孔修补成功率、手术前后平均气骨导差和平均气导听阈。结果 术后随访6个月以上，两组术后平均气骨导差及平均气导听阈均较术前减小，差异均具有统计学意义（P<0.05）。术后两组平均气骨导差及平均气导听阈无明显差异（P>0.05）。术后两组气骨导差缩小值及平均气导听阈缩小值均无明显差异（P>0.05）。试验组术中出血量、手术时间以及住院时长等均小于对照组（P<0.01）。试验组患者鼓膜修补成功率为95.0%（38/40），对照组为92.5%（37/40）。Fisher精确检验表明两种修补材料修补鼓膜穿孔成功率无明显差异（OR=1.53，95%CI=0.17~19.30，P=1）。结论 耳内镜下耳屏软骨膜-软骨岛与颞肌筋膜修补鼓膜穿孔均有较好的疗效，能够改善患者听力，但耳屏软骨膜-软骨岛修补具有微创、高效的特点，更值得临床推广使用。

Abstract:

Objective To compare the clinical effect of tympanic membrane perforation repair with perichondrium-cartilage island and temporal muscle fascia under otoendoscope.Methods Clinical data of 80 patients with tympanic membrane perforation repaired under otoendoscope in Xuzhou Central Hospital from Feb 2018 to March 2020 were analyzed retrospectively. All the patients were divided into two groups according to the repair material. There were 40 cases in the control group (temporalis myofascial repair group) and 40 in the experimental group (perichondrium-cartilage island repair group). The intraoperative blood loss, operation time, hospitalization time, success rate of tympanic membrane repair, and average air-bone gap (ABG) as well as the difference of pre- and postoperative average air conduction hearing threshold(PTA)were compared between the two groups.Results All the patients had been followed up for at least 6 months postoperatively. The postoperative average ABG and PTA were significantly reduced in both groups (all P<0.05). The differences of postoperative average ABG and PTA between the two groups were statistically insignificant (both P>0.05). There were no significant differences between the two groups in the reductions of ABG and PTA (both P<0.05). The intraoperative blood loss, operation time and length of hospital stay in the experimental group were less than those in the control group (all P<0.01). The success rate of tympanic membrane repair was 95.0% (38/40) in the experimental group and 92.5% (37/40) in the control group, the difference was statistically insignificant (Fisher exact test OR=1.53, 95%CI=0.17-19.3, P=1).Conclusions Both tragus perichondrium-cartilage island and temporal myofascial repair of tympanic membrane perforation under otoendoscope have good curative effect, which can improve the hearing of patients. However, tragus perichondrium-cartilage island repair has advantages of minimal invasion and high efficiency, which is more worthy of clinical application.