马宁 陈敏 刘薇 杨扬 邵剑波 郝津生 刘冰 张晓 张杰*

MA Ning, CHEN Min, LIU Wei, YANG Yang, SHAO Jianbo, HAO Jinsheng, LIU Bing, ZHANG Xiao, ZHANG Jie*Department of Otolaryngology Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University,

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 回顾性分析2016年03月-2020年09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。包括患儿年龄、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年-5年。采用SPSS22.0软件，对数据进行统计学分析。结果 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%，低于＞10岁患儿91.67%。合并中耳炎患儿闭合率为74.47%，低于不合并中耳炎患儿。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。小于10岁患儿及合并感染因素不易闭合。

Abstract:

Objective To evaluate the success of Endoscopic Type 1 Tympanoplasty in Pediatric Patients Using island cartilage and perichondrium, and to analyze prognostic factors and long-term efficacy. Methods Medical records of 64 children who underwent type 1 tympanoplasty for tympanic membrane perforation between March 2016 and September 2020 in otolaryngology head and neck surgery department of Beijing Children's Hospital were reviewed. Age, gender, whether combined with 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), surgical approach and length of follow up were recorded. SPSS22.0 software was used for statistical analysis of the data. Results The anatomic closure rate was 80.3% and the functional success rate was 86.36%.The closure rate of ≤10 years old children was 73.81%, lower than that of > 10 years old children 91.67%. The closure rate of children with otitis media was 74.47%, lower than that of children without otitis media. Conclusion Infectious factors are the main causes of perforation of eardrum in children and and are also associated with adverse outcomes. Type I tympanoplasty in children using island cartilage and perichondrium as repair material under otoscope has higher closure rate and functional success rate. The operation could improve the hearing level of children. Children younger than 10 years are less likely to close.