耳内镜下中耳手术及鼓室成形术效果分析

发布时间：2018-05-22 11:04

本文选题：耳内镜 + 鼓室成形术　；参考：《中华耳科学杂志》2017年04期

【摘要】：目的探讨耳内镜下鼓室成形的可行性及疗效。方法回顾性分析2016年5月至2017年4月我科采用耳内镜下对42例慢性化脓性中耳炎、上鼓室胆脂瘤及鼓室硬化症的患者进行鼓室探查、上鼓室进路乳突根治加鼓室成型术,观察鼓膜愈合成功率,并比较手术前及手术后3个月平均气导听阈(PTA)及气骨导差(A-B gap)。结果42例患者术后鼓膜一期完全愈合40例(占95.2%),遗留穿孔2例(占4.8%)者均在门诊耳内镜下处理后完全愈合。术前患者平均气导听阈52.32±14.70 d B HL,术后3个月平均气导听阈30.59±12.16 d B HL,听力提高程度具有统计学意义(P0.001)。3例患者术后出现皮瓣部分缺血坏死,经门诊处理后恢复。未出现严重感音神经性耳聋,无面瘫及眩晕并发症。结论:耳内镜下中耳手术及鼓室成形术具有良好的可行性。部分经过选择的中耳胆脂瘤也适合耳内镜下进行。耳内镜下具有视野广阔清晰,手术时间较短、术中出血量少、术后恢复快及听力效果良好、并发症少等优点,是未来中耳手术的一个热点及方向,但单手操作等缺点仍需术者熟练克服。
[Abstract]:Objective to investigate the feasibility and curative effect of tympanoplasty under endoscope. Methods from May 2016 to April 2017, 42 patients with chronic suppurative otitis media, upper tympanic cholesteatoma and tympanic sclerosis were studied retrospectively. The successful rate of tympanic membrane healing was observed, and the mean air conduction hearing threshold (PTAA) and air-bone conductance difference (A-B Gapa) were compared before and 3 months after operation. Results 40 cases (95.2%) of tympanic membrane healed completely after operation, and 2 cases (4.8%) of residual perforation were completely healed by endoscopy in outpatient department. The mean air conduction hearing threshold was 52.32 卤14.70 d B HL, before operation. The average hearing threshold was 30.59 卤12.16 d B HL, after operation. There was significant difference in the degree of hearing improvement in 3 months after operation (P 0.001). 3 patients had partial ischemic necrosis of skin flap after operation and recovered after outpatient treatment. There were no severe sensorineural deafness, facial paralysis and vertigo complications. Conclusion: endoscopic middle ear surgery and tympanoplasty are feasible. Part of the selected middle ear cholesteatoma is also suitable for endoscopy. Endoscopy has the advantages of broad and clear visual field, short operative time, less blood loss during operation, quick recovery after operation, good hearing effect and fewer complications. It is a hot spot and direction of middle ear surgery in the future. However, the shortcomings of one-hand operation still need to be overcome skillfully.
【作者单位】：中山大学孙逸仙纪念医院耳鼻喉科;
【基金】：广东省科技计划项目(创新项目(民生专项)(2013B02200051) 广州市协同2014Y2-00511)~~
【分类号】：R764.9

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