Beijing Tongren Hospital
目的：对耳内镜下内衬法和夹层法完成慢性化脓性中耳炎患者鼓膜修补术进行疗效观察。方法：回顾性分析2019 年 6月至2021年6月收治的经耳内镜行鼓膜修补的慢性化脓性中耳炎患者的临床资料，比较其手术前后鼓膜愈合情况及听力改善情况。结果：共66例慢性化脓性中耳炎患者入组观察，由同一术者分别以内衬法和夹层法（各33例）完成I型鼓室成形术。在内衬组33例鼓膜穿孔的患者中，31例愈合，愈合率为93.9%；夹层组33例鼓膜穿孔的患者中，32例愈合，愈合率97%。内衬组术前气骨导差21.76±9.43dBHL，术后气骨导差15.97±8.60dBHL，ABG平均提高6dBHL(P=0.011)。夹层组术前气骨导差19.06±8.40dBHL，术后气骨导差12.30±7.23dBHL，ABG平均提高7dBHL(P=0.001)。结论：经耳内镜下以内衬法和夹层法行鼓膜修补术，都能达到较理想的鼓膜愈合状态及听力改善情况。耳内镜手术耗时少、术后住院日短，在耳外科领域中有极大的发展空间。
Objective: To observe the curative effect of endoscopic myringoplasty by inlay method and sandwich method with chronic suppurative otitis media. Methods: We retrospectively analyzed the clinical data of patients with chronic suppurative otitis media who underwent myringoplasty via endoscope between June 2019 and June 2021, and compared the repaired feature of tympanic membrane and hearing improvement pre- and post-operatively. Results: A total of 66 patients were enrolled for the observation. The same surgeon performed type I tympanoplasty with the inlay method or sandwich method (33 cases in each group). In the inlay group, 31 of 33 patients achieved a satisfactory healing of tympanic membrane perforation with a healing rate of 93.9%. In the sandwich group, 32 of 33 patients with tympanic membrane perforation got repaired successfully with a healing rate of 97%. In the inlay group, the pre-operative and post-operative air-bone gap was 21.76±9.43dBHL and 15.97±8.60dBHL, respectively, with an increase of 6dBHL on average (P=0.011). In the sandwich group, the pre-operative and post-operative air-bone gap was 19.06±8.40dBHL and 12.30±7.23dBHL, respectively, with an increase of 7dBHL on average(P=0.001). Conclusion: The inlay method and the sandwich method under the endoscope can achieve an ideal tympanic membrane healing and hearing improvement indistinguishably. In addition, endoscopic surgery was less time-consuming and needed shorter length of stay in hospital. There was bright future for the development of otoscopic surgery.