耳内镜与显微镜下Ⅰ型鼓室成形术的临床疗效分析

Surgical effect analysis of endoscopic and microscopic type I tympanoplasty

摘要:

目的 探讨耳内镜与显微镜下Ⅰ型鼓室成形术治疗鼓膜穿孔患者的临床疗效。方法 收集2017年1月-2020年10月因慢性化脓性中耳炎行Ⅰ型鼓室成形术122例（122耳），其中耳内镜下Ⅰ型鼓室成形术（ETT）62例；显微镜下Ⅰ型鼓室成形术（MTT）60例。所有患者术后均随访6个月以上，比较两组患者术中出血量、鼓索神经损伤率、手术时间、术后出院时间、住院费用，鼓膜愈合情况，对手术前与术后6个月的平均气导听阈（PTA），气骨导差（ABG）进行分析，采用视觉模拟评分（VAS）评估患者术后24h疼痛反应。结果 ETT组具有术中出血量少、手术时间短、术后疼痛反应轻、出院时间缩短、住院总费用少等优越性，两组差异具有统计学意义（P<0.05）。ETT和MTT组中鼓膜愈合率分别为93.5%和90.0%，鼓索神经损伤率分别为6.5%和8.3%；ETT组术前PTA为（43.2±11.3）dB、AGB为（19.8±8.6）dB，MTT组术前PTA为（45.6±12.1）dB，AGB为（21.3±9.4）dB。术后6个月复查PTA两组均下降，ETT组为（33.7±8.3）dB，MTT组为（35.3±9.1）dB；复查ABG两组均下降，ETT组为（9.4±6.1）dB，MTT组为（10.7±6.4）dB。两组术式差异无统计学意义（P>0.05）。结论 与MTT相比，ETT能明显减轻术后疼痛、缩短手术时间、住院时间，减少总住院费。在术后穿孔修补、听力改善以及并发症等方面与传统手术MTT疗效相当，值得在中耳手术中推广使用。

Abstract:

Objective To investigate the surgical effect of endoscopic and microscopic type I tympanoplasty for tympanic membrane perforation.Methods One hundred and twenty-two patients(122 ears)with chronic suppurative otitis media treated with type I tympanoplasty in our department from Jan 2017 to Oct 2020 were included. Of them, 62 received endoscopic tympanoplasty(ETT)and 60 received microscopic tympanoplasty (MTT). The postoperative follow-up period was at least 6 months. The intraoperative bleeding, chorda tympani nerve injury rate, operation time, postoperative discharge time, total hospitalization expense, graft success rate,pre- and post-operative average air conduction hearing threshold (PTA), air-bone gap (ABG) were compared between the two groups, and visual analogue score (VAS) was adopted to evaluate postoperative pain within 24 h.Results Compared with the MTT group, the ETT group had less intraoperative blood loss, shorter operation time, lighter postoperative pain, and shorter discharge time, as well as less total hospitalization expenses. All the differences were statistically significant (all P<0.05). The graft success rates in the ETT and MTT groups were 93.5% and 90%, and intraoperative chorda tympani nerve injury rates were 6.5% and 8.3%, respectively. The preoperative PTA and AGB of the ETT group were (43.2±11.3) dB and (19.8±8.6) dB, and those of the MTT group were (45.6±12.1) dB and (21.3±9.4) dB, respectively. At 6 months after operation, the PTAs of the ETT and MTT groups decreased, which were (33.7±8.3) dB and (35.3±9.1) dB, and their ABGs were reduced to (9.4±6.1) dB and (10.7±6.4) dB respectively. The differences between the two groups were statistically insignificant (P>0.05).Conclusion Compared with MTT, ETT significantly reduces postoperative pain, shortens operation time, hospital stay, and reduces total hospital expenses. With equivalent postoperative perforation repair, hearing improvement and complications to MTT, ETT is worthy of popularization in middle ear surgery.