耳内镜干、湿耳状态下Ⅱ型鼓室成形术疗效分析

doi:10.3760/cma.j.cn101202-20210620-00158

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摘要目的比较耳内镜干、湿耳状态下Ⅱ型鼓室成形术的疗效,评估湿耳下Ⅱ型鼓室成形术的可行性。方法回顾性队列研究。纳入安徽医科大学第一附属医院耳鼻咽喉头颈外科2018年1月—2020年10月40例耳内镜下Ⅱ型鼓室成形术的慢性中耳炎患者的临床资料。其中,男14例、女26例,年龄18~72岁。依据术前鼓室黏膜炎性状态分为湿耳组22例和干耳组18例。观察指标：（1）比较2组患者性别、年龄、病程、手术时间、术前骨气导差等基线资料;（2）比较2组患者术后3个月时听力改善情况;（3）观察2组患者鼓膜愈合情况,比较手术前后4 kHz骨导听阈的变化以及术后并发症发生情况。结果 2组患者术后均获得干耳,无再次流脓。（1）2组患者的年龄、病程、术前骨气导差、手术时间等基线资料比较差异均无统计学意义（P值均 > 0.05）,性别构成差异有统计学意义（P = 0.028）。（2）术后3个月听力改善情况：湿耳组、干耳组气导的平均听阈术前分别为（63.03±16.63）dB、（53.89±13.85）dB,术后分别为（46.59±13.86）dB、（39.51±12.92）dB,差异均有统计学意义（t = 13.35、10.13,P值均 < 0.001）;骨导平均听阈术前分别为（30.30±13.48）dB、（26.25±9.94）dB,术后分别为（30.10±12.53）dB、（26.11±9.55）dB,差异均无统计学意义（t = 0.47、0.36,P = 0.642、0.723）。2组患者骨气导差术后均较术前显著降低,其中干耳组由（27.2 ± 9.4）dB降至（13.4 ± 6.4）dB,湿耳组由（32.7 ± 9.0）dB降至（16.5 ± 4.8）dB,差异均有统计学意义（t =10.24、14.34,P值均 < 0.001）。2组间比较,手术前后骨气导差以及术后骨气导差的降低值差异均无统计学意义（P值均 > 0.05）,2组手术前后4 kHz骨导听阈差异无统计学意义（P > 0.05）。（3）2组患者随访3个月,鼓膜均完全愈合,均未出现感音神经性聋、面瘫等并发症。结论耳内镜湿耳状态下Ⅱ型鼓室成形术后患者的听力恢复及鼓膜愈合情况与干耳状态疗效相当,该手术是可行的。

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关键词 ：中耳炎, 自然腔道内镜手术, 耳内镜, 湿耳, 鼓室成形, 部分人工听骨

Key words： Otitis media Natural orifice endoscopic surgery Endoscopy Wet ears Tympanoplasty Partial ossicular replacement prostheses

收稿日期: 2021-06-20

通讯作者: 高潮兵,Email： gcb110011@163.com

引用本文:

汪东, 华红婷, 赵益, 童步升, 高潮兵, 方平. 耳内镜干、湿耳状态下Ⅱ型鼓室成形术疗效分析[J]. 中华解剖与临床杂志, 2022, 27(4): 285-288.
Wang Dong, Hua Hongting, Zhao Yi, Tong Busheng, Gao Chaobing, Fang Ping. Efficacy analysis of endoscopic type Ⅱ tympanoplasty in dry and wet ear. Chinese Journal of Anatomy and Clinics, 2022, 27(4): 285-288.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20210620-00158 或 http://www.cjac.com.cn/CN/Y2022/V27/I4/285

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