耳内镜下锤骨柄反向部分脱袜Ⅰ型鼓室成形术的疗效分析

Efficacy analysis of reverse partial malleus handle detachment technique in endoscopic type I tympanoplasty

摘要:

目的 探讨耳内镜下锤骨柄反向部分脱袜后行I型鼓室成形术的临床效果，并介绍其手术特点。方法 回顾性分析2022年3月—2023年9月在湘雅医院耳科行耳内镜下鼓室成形手术的患者32例(32耳)。患者根据手术方式分为两组，观察组16例(16耳)采用耳内镜下蒂在前方的外耳道鼓膜瓣180°掀起、锤骨柄反向部分脱袜至近锤骨短突后行内-外植法鼓室成形术；对照组16例(16耳)采用耳内镜下常规蒂在前下的外耳道鼓膜瓣270°掀起、锤骨柄完全脱袜后行内-外植法鼓室成形术。比较两组患者手术时间、出血量、鼓膜愈合情况、术后听力改善情况及手术并发症。使用SPSS 26.0软件进行数据分析。结果 观察组和对照组手术时间分别为(46.9±6.3)、(60.2±12.7)min，差异具有统计学意义(P<0.05);手术出血量分别为(1.9±1.0)、(4.1±1.6)mL，差异具有统计学意义(P<0.05)。术后6个月，两组患者鼓膜愈合率均为100%。观察组术前及术后气导听阈、气骨导差分别为(24.9±7.9)、(15.5±6.1)dB HL和(19.3±6.1)、(9.8±4.7)dB HL，平均提高9.5 dB HL，差异均具有统计学意义(P<0.05)。对照组术前及术后气导听阈、气骨导差分别为(28.6±7.1)、(18.9±6.8)dB HL和(22.9±6.1)、(13.2±5.2)dB HL，平均提高9.7 dB HL，差异均具有统计学意义(P均<0.05)。结论 与耳内镜下常规蒂在前下的外耳道鼓膜瓣270°掀起、锤骨柄完全脱袜后行内-外植法鼓室成形术相比，耳内镜下蒂在前方的外耳道鼓膜瓣180°掀起、锤骨柄反向部分脱袜至近锤骨短突后行内-外植法鼓室成形术在手术成功率相同的情况下，具有手术时间短、出血少、创伤更小的优势。

Abstract:

Objective To explore the clinical outcomes of endoscopic type I tympanoplasty performed with reverse partial detachment of the malleus handle and to introduce the surgical characteristics. Methods A retrospective analysis was conducted on 32 patients (32 ears) who underwent endoscopic tympanoplasty in the Department of Otolaryngology, Xiangya Hospital from March 2022 to September 2023. The patients were divided into two groups based on the surgical methods. The observation group 16 patients (16 ears) underwent endoscopic elevation of the anterior external auditory canal tympanic membrane flap at 180°, with reverse partial detachment of the malleus handle to near the short process of the malleus followed by over-under tympanoplasty. The control group 16 patients (16 ears) received conventional endoscopic elevation of the anterior-inferior external auditory canal tympanic membrane flap at 270°, with complete detachment of the malleus handle followed by over-under tympanoplasty. The operation time, blood loss volume, tympanic membrane healing, postoperative hearing improvement, and surgical complications were compared between the two groups. Data analysis was performed using SPSS 26.0 software. Results The operation time of the observation group and the control group were (46.9±6.3) minutes and (60.2±12.7) minutes respectively, and the difference was statistically significant (P<0.05). Their blood loss volumes were (1.9±1.0) mL and (4.1±1.6) mL respectively, with a statistically significant difference (P<0.05). Six months after operation, the tympanic membrane healing rates of both groups were 100%. The preoperative and postoperative air conduction thresholds and air-bone gaps in the observation group were (24.9±7.9) dBHL and (15.5±6.1) dBHL, (19.3±6.1) dBHL and (9.8±4.7) dBHL, respectively, with an average improvement of 9.5 dBHL, which were all statistically significant (P<0.05). Those in the control group were (28.6±7.1) dBHL and (18.9±6.8) dBHL, (22.9±6.1) dBHL and (13.2±5.2) dBHL, respectively, with an average improvement of 9.7 dBHL, and the differences were all statistically significant (all P<0.05). Conclusion Compared to conventional endoscopic elevation of the anterior-inferior external auditory canal tympanic membrane flap at 270° with complete detachment of the malleus handle followed by over-under tympanoplasty, the endoscopic elevation of the anterior external auditory canal tympanic membrane flap at 180° with reverse partial detachment of the malleus handle to near the short process of the malleus followed by over-under tympanoplasty has the advantages of shorter operation time, less blood loss, and less trauma with the same surgical success rate.