耳内镜下利用岛状软骨-软骨膜为修补材料的儿童Ⅰ型鼓室成形术

Endoscopic type I tympanoplasty in pediatric patients using island cartilage and perichondrium

摘要:

目的 评估耳内镜下利用岛状软骨-软骨膜为修补材料儿童Ⅰ型鼓室成形术的临床预后，分析相关影响因素及远期疗效。方法 收集2016年3月-2020年9月北京儿童医院耳鼻咽喉头颈外科就诊的64例鼓膜穿孔患儿临床资料，患儿年龄4~17岁，中位年龄8岁5个月。分析患儿年龄、性别、穿孔原因、是否合并化脓性中耳炎、鼓膜穿孔部位及大小、咽鼓管功能评分、术前及术后听力情况、手术方式等。随访1~5年，采用SPSS 22.0统计软件，对数据进行统计学分析。结果 64例患儿共完成手术66侧，解剖闭合率为80.3%，功能成功率为86.36%。≤ 10岁患儿闭合率为73.81%，>10岁患儿闭合率为91.67%；合并中耳炎患儿闭合率为74.47%，不合并中耳炎患儿闭合率为94.73%。结论 感染因素是导致儿童鼓膜穿孔的主要原因，也与不良结局有关。耳内镜下利用岛状软骨-软骨膜为修补材料儿童Ⅰ型鼓室成形术有较高的闭合率和功能成功率。≤ 10岁患儿及合并感染因素不易闭合。

Abstract:

Objective To evaluate the clinical outcome of endoscopic type I tympanoplasty in pediatric patients using island cartilage and perichondrium, and to analyze prognostic factors and long-term efficacy.Methods Clinical data of 64 children who underwent type I tympanoplasty for tympanic membrane perforation between March 2016 and Sept 2020 in our department were analyzed retrospectively. Their age range was from 4 years, 11 months and 2 days to 17 years, 4 months and 5 days with a median age of 8 years and 5 months. The analyzed data included patients' age and gender, combined suppurative otitis media, perforation reason and location of perforation (anterior, posterior, inferior), eustachian tube function score, pre- and post-operative hearing levels, mean air-bone gap (ABG), and surgical approach. SPSS 22.0 software was used for statistical analysis of the data.Results Endoscopic type I tympanoplasty was performed in 64 children (66 ears). The anatomic closure rate was 80.3% and the functional success rate was 86.36%. The closure rate of ≤ 10-year-old children was 73.81%, which was lower than that of >10-year-old children (91.67%). The closure rate of children with otitis media was 74.47%, which was lower than that of children without otitis media(94.73%).Conclusions Infectious factors are the main causes of perforation of eardrum in children and are also associated with adverse outcomes. Type I tympanoplasty in children using island cartilage and perichondrium as repair material under otoscope has high closure rate and functional success rate. Patient's age younger than 10 and infection are factors of poor outcome.