经耳内镜鼓室成形术治疗鼓膜大穿孔的疗效分析

董健菲; 戴艳红; 陈杰; 周函; 高下; 陆玲

doi:10.16766/j.cnki.issn.1674-4152.003279

经耳内镜鼓室成形术治疗鼓膜大穿孔的疗效分析

doi: 10.16766/j.cnki.issn.1674-4152.003279

董健菲^{1, 2},
戴艳红^{1, 2},
陈杰^{1, 2},
周函^{1, 2},
高下^{1, 2},
陆玲^{1, 2, ,}

1.
南京大学医学院附属鼓楼医院耳鼻咽喉头颈外科，江苏南京 210008
2.
南京大学医学院附属鼓楼医院耳鼻咽喉研究所

基金项目:

国家自然科学基金项目 82071059

南京市医学科技发展资金资助项目 YKK20069

详细信息

通讯作者:
陆玲，E-mail：entluling60@126.com

中图分类号: R764.82 R764.92
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出版历程
- 收稿日期: 2023-03-04

Effect of transauricular endoscopic tympanoplasty in the treatment of large tympanic membrane perforation

DONG Jianfei^{1, 2},
DAI Yanhong^{1, 2},
CHEN Jie^{1, 2},
ZHOU Han^{1, 2},
GAO Xia^{1, 2},
LU Ling^{1, 2
, ,}

1.
Department of Otolaryngology-Head and Neck Surgery, Nanjing Drum Tower Hospital of Nanjing University School of Medicine, Nanjing, Jiangsu 210008, China

摘要

摘要: 目的探讨耳内镜下外耳道皮瓣-鼓环-残余鼓膜360°全掀内置法行鼓室成形术治疗鼓膜大穿孔的临床效果，并介绍临床手术要点和技巧。方法选择2019年7月—2021年12月在南京鼓楼医院接受鼓室成形术的鼓膜大穿孔患者30例(30耳)，根据手术方式分组，其中观察组15例(15耳)接受耳内镜下外耳道皮瓣-鼓环-残余鼓膜360°全掀起后经内置法行鼓室成形术，对照组15例(15耳)接受耳内镜下常规外耳道后壁皮瓣-鼓环-残余鼓膜270°掀起后经内置法行鼓室成形术。术后随访6个月，比较2组手术时间、出血量、鼓膜愈合情况、术后听力改善情况。结果观察组和对照组手术时间分别为(108.33±8.28)min和(111.00±12.96)min，差异无统计学意义；手术出血量分别为(13.00±3.00)mL和(12.07±3.31)mL，差异无统计学意义。观察组术后随访6个月时鼓膜修补成功率为100.00%(15/15)，对照组修补成功率为86.67%(13/15)。观察组听力改善12例(80.00%)，对照组听力改善9例(60.00%)，但差异无统计学意义(P>0.05)。结论与耳内镜下常规外耳道后壁皮瓣-鼓环-残余鼓膜270°掀起后经内置法行鼓室成形术相比，耳内镜下外耳道皮瓣-鼓环-残余鼓膜360°全掀起后经内置法行鼓室成形术在治疗鼓膜大穿孔中不仅同样具有手术时间短的优势，还可以提高患者的鼓膜修补成功率和术后听力。
- 耳内镜 /
- 鼓膜穿孔 /
- 鼓室成形术 /
- 鼓环 /
- 听力
Abstract: Objective To investigate the clinical effect of underlay (medial) tympanoplasty of "external auditory canal flap-tympanic annulus-residual tympanic membrane 360 degree full lift" under oto-endoscope for the treatment of large tympanic membrane perforation, and to introduce the key points and techniques of clinical surgery. Methods Thirty patients (30 ears) with large tympanic membrane perforation who underwent tympanoplasty at Nanjing Drum Tower Hospital from July 2019 to December 2021 were selected. They were divided into groups according to the type of surgery. In the observation group, 15 patients (15 ears) underwent tympanoplasty by underlay (medial) tympanoplasty after the external auditory canal flap, drum ring and residual tympanic membrane were completely opened under oto-endoscope. In the control group, 15 cases (15 ears) underwent underlay (medial) tympanoplasty after 270-degree elevation of the external auditory canal posterior wall flap, tympanic ring and residual tympanic membrane under oto-endoscope. Postoperative follow-up was conducted for 6 months, and operative time, blood loss, tympanic healing and postoperative hearing were compared between the two groups. Results The mean operating times of the observation group and the control group were (108.33±8.28) min and (111.00±12.96) min, respectively, with no statistical significance. The mean blood loss were (13.00±3.00) mL and (12.07±3.31) mL, respectively, and the difference was not statistically significant. The success rate of tympanic membrane repair at 6 months was 100.00% (15/15) in the observation group and 86.67% (13/15) in the control group. There were 12 cases (80.00%) of hearing improvement in the observation group and 9 cases (60.00%) in the control group, however, the difference was not statistically significant (P>0.05). Conclusion Compared to conventional tympanoplasty with underlay (medial) tympanoplasty after 270 degrees of external ear canal flap, tympanic annulus and residual tympanic membrane under oto-endoscope, tympanoplasty with underlay (medial) tympanoplasty after 360 degrees of full flap, tympanic annulus and residual tympanic membrane and residual tympanoplasty under oto-endoscope has the same advantages in the treatment of large tympanic membrane perforation, but it can improve the success rate of repair and postoperative hearing of patients.
- Oto-endoscopy /
- Tympanic membrane perforation /
- Tympanoplasty /
- Tympanic ring /
- Hearing
利益冲突 无

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图 1 2组鼓膜大穿孔患者鼓膜修补前

注：A为观察组，B为对照组。

Figure 1. Preoperative phenotypes for two patients with large tympanic membrane perforation prior to repair

下载: 全尺寸图片幻灯片

图 2 2组鼓膜大穿孔患者鼓膜修补后

注：A为观察组，B为对照组。

Figure 2. Phenotypes of two patients with large tympanic membrane perforation following the membrane repair

下载: 全尺寸图片幻灯片

图 3 观察组鼓膜大穿孔患者术后2个月的鼓膜愈合情况

注：术后复查的耳内镜照片。

Figure 3. Two-month post-surgery observation study on tympanic membrane healing in patients with large perforation

下载: 全尺寸图片幻灯片

表 1 2组鼓膜大穿孔患者手术时间及术中出血量比较(x±s)

Table 1. Comparing operation time and intraoperative blood loss between two groups of patients with large tympanic membrane perforation(x±s)

组别	例数	手术时间(min)	术中出血量(mL)
观察组	15	108.33±32.05	13.00±11.62
对照组	15	111.00±50.19	12.07±12.83
t值		0.174	0.209
P值		0.864	0.836

下载: 导出CSV

表 2 2组鼓膜大穿孔患者手术前后听力情况比较(x±s，dB)

Table 2. Comparing pre- and post-operative hearing in two groups of patients with large tympanic membrane perforation(x±s, dB)

组别	例数	术前气导阈值	术后气导阈值	术后气骨导差
观察组	15	54.72±16.99	46.22±17.48	24.46±10.95
对照组	15	56.72±19.86	48.26±17.38	22.38±10.45
t值		0.296	0.321	0.532
P值		0.769	0.751	0.599

下载: 导出CSV

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