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
计量
- 文章访问数: 133
- HTML全文浏览量: 27
- PDF下载量: 16
- 被引次数: 0
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

HTML全文

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

参考文献(15)

[1]	陆达锴, 张祥宝, 康骋, 等. 组织工程鼓膜的研究进展[J]. 中华耳科学杂志, 2020, 18(4): 806-809. LU D K, ZHANG X B, KANG P, et al. Research progress on tissue engineering of tympanic membrane[J]. Chinese Journal of Otology, 2020, 18(4): 806-809.
[2]	王莹, 关兵, 徐丽, 等. 耳内镜下耳屏软骨-软骨膜和耳屏软骨膜修补鼓膜大穿孔疗效分析[J]. 中国耳鼻咽喉头颈外科, 2022, 29(10): 626-629. WANG Y, GUAN B, XU L, et al. Clinical analys is on endoscopic repairment of tympanic membrane perforation with tragus cartilage perichondrium and tragus perichondrium[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2022, 29(10): 626-629.
[3]	冀庆军, 柴伟, 黄辉, 等. 耳内镜与显微镜下夹层法修补鼓膜大穿孔的疗效比较[J]. 听力学及言语疾病杂志, 2020, 28(1): 92-94. JI Q J, CHAI W, HUANG H, et al. Comparison of the curative effect of ear endoscopy and microscope dissection in repairing large perforation of tympanic membrane[J]. Journal of Audiology and Speech Pathology, 2020, 28(1): 92-94.
[4]	郭志鹏, 崔瑞平, 刘慧芳, 等. 耳内镜下鼓膜成形术在治疗鼓膜大穿孔中的应用价值分析[J]. 现代诊断与治疗, 2020, 31(16): 2612-2614. GUO Z P, CUI R P, LIU H F, et al. Application value analysis of endoscopic myringoplasty in the treatment of large perforation of tympanic membrane[J]. Modern Diagnosis & Treatment, 2020, 31(16): 2612-2614.
[5]	苏丽云, 郭清华. 鼓膜穿孔修补术式及手术修补材料的研究进展[J]. 全科口腔医学电子杂志, 2019, 6(22): 12, 15. GUO L Y, GUO Q H. Research progress on repair methods and materials of tympanic membrane perforation[J]. Electronic Journal of General Stomatology, 2019, 6(22): 12, 15.
[6]	中华医学会耳鼻咽喉头颈外科学分会耳科学组, 中华耳鼻咽喉头颈外科杂志编辑委员会耳科组. 中耳炎临床分类和手术分型指南(2012)[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(2): 5. Department of Otolaryngology Head and Neck Surgery, Chinese Medical Association, Chinese Journal of Otolaryngology, Head and Neck Surgery, Editorial Board, Ear Group. Guidelines for clinical and surgical classification of otitis media (2012)[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2013, 48(2): 5.
[7]	谷长宏, 王升举. 完壁式乳突根治并鼓室成形术治疗慢性化脓性中耳炎的临床有效性分析[J]. 临床和实验医学杂志, 2021, 20(1): 104-107. GU C H, WANG S J. Analysis of clinical efficacy of mastoid radical resection combined with tympanoplasty in the treatment of chronic suppurative otitis media[J]. Journal of Clinical and Experimental Medicine, 2021, 20(1): 104-107.
[8]	王杰, 王桑, 孙雅静. 完壁式乳突切除术联合鼓室成形术治疗慢性化脓性中耳炎的疗效分析[J]. 中国眼耳鼻喉科杂志, 2018, 18(1): 36-39. WANG J, WANG S, SUN Y J. Effect of canal wall up mastoidectomy with tympanoplasty on the treatment of chronic suppurative otitis media[J]. Chinese Journal of Ophthalmology and Otorhinolaryngology, 2018, 18(1): 36-39.
[9]	BRENNAN-JONES C G, HEAD K, CHONG L Y, et al. Topical antibiotics for chronic suppurative otitis media[J]. Cochrane Database Syst Rev, 2020, 1(1): CD013051. DOI: 10.1002/14651858.CD013051.
[10]	李珊, 柯嘉, 马芙蓉. 耳内镜下鼓室成形术的临床研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(9): 853-856. LI S, KE J, MA F R. Clinical research advances of endoscopic tympanoplasty[J]. Journal of Clinical Otorhinolaryngology Head And Neck Surgery, 2020, 34(9): 853-856.
[11]	左文娜, 朱虹, 金爱燕, 等. 52例耳内镜下鼓膜紧张部边缘性大穿孔行鼓膜修补术后短期疗效观察[J]. 遵义医科大学学报, 2022, 45(3): 387-391. ZUO W N, ZHU H, JIN A Y, et al. Short-term efficacy of tympanic membrane repair for 52 cases of marginal large perforation of tension part under endoscope[J]. Journal of Zunyi Medical University, 2022, 45(3): 387-391.
[12]	张春林, 邓原, 龙丹, 等. 耳内镜下鼓膜大穿孔鼓室成形术及其临床疗效分析[J]. 中山大学学报(医学科学版), 2019, 40(6): 897-903. ZHANG C L, DENG Y, LONG D, et al. Clinical Efficacy of Endoscopic Tympanoplasty for Large Tympanic Membrane Perforation[J]. Journal of Sun Yat-sen University(Medical Sciences), 2019, 40(6): 897-903.
[13]	王登元, 陈智斌, 邢光前. 耳内镜微创术: 耳科手术的新途径[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 27-30. WANG D Y, CHEN Z B, XING G Q. Minimally invasive otoendoscopic surgery: a new path for ear surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 27-30.
[14]	丁曌冉, 蒋成义, 王伟, 等. 耳内镜下鼓膜修补手术治疗湿耳期中耳炎的临床疗效分析[J]. 中华全科医学, 2021, 19(2): 212-216. doi: 10.16766/j.cnki.issn.1674-4152.001770 DING Z R, JIANG C Y, WANG W, et al. Analysis of clinical efficacy of tympanic membrane repair surgery under otoscope under wet ear stage[J]. Chinese Journal of General Practice, 2021, 19(2): 212-216. doi: 10.16766/j.cnki.issn.1674-4152.001770
[15]	侯昭晖, 王方园, 吴南, 等. 耳内镜外科技术教学与培训的思考[J]. 中华耳科学杂志, 2020, 18(1): 199-203. HOU Z H, WANG F Y, WU N, et al. Thoughts on training of endoscopic ear surgeries[J]. Chinese Journal of Otology, 2020, 18(1): 199-203.