耳内镜下耳屏软骨环-软骨膜修补术治疗鼓膜穿孔40例

doi:10.6040/j.issn.1673-3770.0.2018.203

摘要/Abstract

摘要： 目的探讨耳内镜下耳屏软骨环-软骨膜修补术治疗鼓膜穿孔的疗效。方法将80例(80耳)鼓膜穿孔患者按随机数字表法随机分为观察组与对照组各40例,观察组行耳内镜下耳屏软骨环-软骨膜修补术,对照组行显微镜下颞肌筋膜鼓膜修补术。对比两组手术时间、术中出血量、临床疗效、鼓膜愈合率、听力恢复情况及术后并发症发生率。结果观察组与对照组手术时间分别为(42.19±12.35)、(82.67±11.16)min,术中出血量分别为(5.06±1.34)、(14.27±2.35)mL,两组手术时间及术中出血量比较,P均<0.05。观察组治愈28例,有效10例,无效2例,总有效率为95.00%(38/40),对照组分别为23、8、9例,77.50%(31/40),两组总有效率比较,P<0.05。观察组与对照组术后1个月鼓膜愈合率分别为95.00%(38/40)、87.50%(35/40),术后6个月鼓膜愈合率分别为92.50%(37/40)、85.00%(34/40),术后12个月鼓膜愈合率分别为92.50%(37/40)、85.00%(34/40),两组术后1、6、12个月鼓膜愈合率比较,P均>0.05。两组术后1、6、12个月听力恢复情况比较差异无统计学意义(P均>0.05)。观察组术后1年内发生再度穿孔3例(7.5%),对照组术后1年内发生再度穿孔6例(15%),两组术后并发症发生率比较差异无统计学意义(χ2=0.501, P=0.479)。结论耳内镜下耳屏软骨环-软骨膜修补术治疗鼓膜穿孔效果确切,可促进患者术后恢复,提高临床疗效及鼓膜愈合率,改善患者听力效果。

关键词: 鼓膜穿孔, 耳内镜, 耳屏软骨环-软骨膜, 疗效

Abstract: Objective To investigate the curative effect of endoscopic tragus cartilage ring perichondrium myringoplasty. Methods Eighty patients(80 ears)with tympanic membrane perforation were randomly divided into observation(endoscopic ear cartilage perichondrium composite ring repair)and control groups(temporalis fascia myringoplasty using an operating microscope), with 40 cases in each group. Clinical indexes, efficacy, tympanic membrane healing rates, hearing recovery, and the incidence of postoperative complications were compared between the two groups. Results The operative time and the amount of bleeding in the observation group were lower than those in the control group(P<0.05). The total efficacy rate in the observation group was higher than that in the control group(P<0.05). The tympanic membrane healing rate in the two groups was not statistically different after 1, 6, and 12 postoperative months(P>0.05). There was no significant difference in hearing recovery between the two groups after 1, 6, and 12 months(P>0.05). There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05). Conclusion Use of endoscopic ear tragus cartilage ring perichondrium myringoplasty to reduce postoperative bleeding shortens the operative time and healing rate, with good clinical curative effect, and can improve hearing, making it clinically useful.

Key words: Auricular endoscopy, Tragus cartilage ring perichondrium, Tympanic membrane perforation, Curative effect

中图分类号:

R764

周庆,刘雄光,吴昌林,叶小武. 耳内镜下耳屏软骨环-软骨膜修补术治疗鼓膜穿孔40例[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 69-72.

ZHOU Qing, LIU Xiongguang, WU Changlin, YE Xiaowu. Clinical observation of 40 cases of tympanic membrane perforation treated with auricular endoscopic cartilage ring and cartilage membrane repair[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(6): 69-72.

参考文献

[1] 王戬,葛前进,康利萍.鼓膜上皮皮瓣推移法修补边缘性鼓膜穿孔27例[J].山东大学耳鼻喉眼学报,2015,29(2):15-16. WANG Jian, GE Qianjin, KANG Liping. Advance flap in repairing marginal perforation of tympanic membrane in 27 cases[J]. J Otolaryngol Ophthal Shandong Univ, 2015, 29(2):15-16.
[2] 王进.内镜下与显微镜下鼓膜大穿孔软骨岛-软骨膜成形术差异分析[J].山东大学耳鼻喉眼学报,2014,28(1):8-9. WANG Jin. Repair of big tympanic membrane perforation with cartilage island-perichondrium under endoscopy and microscopy[J]. J Otolaryngol Ophthal Shandong Univ, 2014, 28(1):8-9.
[3] Yan K, Li J. Treatment of traumatic perforation of tympanic membrane with lens paper under ear endoscope[J]. J Clin Otorhinolaryngol Head Neck Surg, 2013, 27(24):1397.
[4] Habesoglu M, Oysu C, Sahin S, et al. Platelet-rich fibrin for the repair of tympanic membrane[J]. Otolaryngolo Head Neck Surg, 2012, 147(Suppl 2):218.
[5] 孔喆,李云英,向建文,等.言语测听体系评价中医药治疗耳聋耳鸣疗效研究[J].广州中医药大学学报,2017,34(1):47-50. KONG Zhe, LI Yunying, XIANG Jianwen, et al. Evaluation of therapeutic effect of chinese medicine for treatment of deafness and tinnitus with speech detection system[J]. J Guangzhou Univ Traditional Chin Med, 2017, 34(1):47-50.
[6] 王铁锋,徐亚萍.耳内镜下鼓膜大穿孔修补26例[J].中国眼耳鼻喉科杂志,2017,17(3):200-201. WANG Tiefeng, XU Yaping. 26 cases of large perforation of tympanic membrane under ear endoscopy[J]. Chin J Ophthalmol Otorhinolaryngol, 2017, 17(3):200-201.
[7] 程德军,钟锦婵,李少仪.耳内窥镜与显微镜下鼓膜修补术疗效比较[J].中外医学研究,2014,12(20):68-70. CHENG Dejun, ZHONG Jinchan, LI Shaoyi. Comparison of therapeutic effects of tympanoplasty under ear endoscope and microscope[J]. Chin Foreign Med Res, 2014, 12(20):68-70.
[8] Haksever M, Akduman D, Solmaz F, et al. Inlay butterfly cartilage tympanoplasty in the treatment of dry central perforated chronic otitis media as an effective and time-saving procedure[J]. Eur Arch Otorhinolaryngol, 2015, 272(4):867-872.
[9] 李惠,王俊国,钱晓云,等.鼻内镜下鼻中隔软骨、筛骨垂直板或耳屏软骨修补鼻中隔穿孔[J].现代生物医学进展,2017,17(14):2766-2769. LI Hui, WANG Junguo, QIAN Xiaoyun, et al. Nasal septum cartilage, ethmoidal vertical plate or ear cartilage for nasal septal perforation under nasal endoscope[J]. Prog Modern Biomed, 2017, 17(14):2766-2769.
[10] 张少燕,区永康,许耀东,等.耳屏双岛状软骨-软骨膜在上鼓室外侧壁重建及鼓室成形术的临床应用[J].中华显微外科杂志,2016,39(4):395-397. ZHANG Shaoyan, OU Yongkang, XU Yaodong, et al. Clinical application of double island cartilage cartilage membrane in reconstruction of lateral wall of upper drum and tympanoplasty[J]. Chin J Microsurg, 2016, 39(4):395-397.
[11] 杨启梅,张文,韩想利,等.耳内镜下耳屏软骨-软骨膜治疗鼓膜穿孔的临床研究[J].中华耳科学杂志,2016,14(6):778-782. YANG Qimei, ZHANG Wen, HAN Xiangli, et al. Clinical study of auricular cartilage cartilage membrane in the treatment of tympanic membrane perforation[J]. Chin J Otol, 2016, 14(6):778-782.
[12] 王驰,刘星,孔磊,等.耳内镜下耳屏软骨-软骨膜在鼓膜修补中的临床应用[J].现代仪器与医疗,2017,23(6):44-45. WANG Chi, LIU Xing, KONG Lei, et al. Clinical application of auricular cartilage cartilage membrane in tympanic membrane repair[J]. Modern Inst Med Treat, 2017, 23(6):44-45.
[13] 徐隽彦,刘春丽,倪立群.耳内镜下鼓膜置管或穿刺治疗慢性分泌性中耳炎的临床效果对比[J].中国耳鼻咽喉头颈外科,2015,22(1):21-23. XU Junyan, LIU Chunli, NI Liqun, et al. Comparison the clinical effect of tympanostomy tube and tympanocentesis under ear endoscope of chronic secretory otitis media[J]. Chin Arch Otolaryngol Head Neck Surg, 2015, 22(1):21-23.
[14] 薛建亭,朱宝福.内镜下蝶形耳屏软骨嵌入鼓膜修补术32耳[J].中国眼耳鼻喉科杂志,2017,17(4):272-274. XUE Jianting, ZHU Baofu. Effect of endoscopic inlay butterfly cartilage graft myringoplasty technique on the treatment of tympanic membrance perforation[J]. Chin J Ophthalmol Otorhinolaryngol, 2017, 17(4):272-274.
[15] 李鹏,张奕,符秋养,等.耳内镜下耳屏软骨-软骨膜修补鼓膜大穿孔的临床观察[J].临床耳鼻咽喉头颈外科杂志,2014,28(22):1762-1764. LI Peng, ZHANG Yi, FU Qiuyang, et al. The clinical observation of auricular cartilage cartilage membrane repair for large perforation of tympanic membrane under ear endoscope[J]. J Clin Otorhinolaryngol Head Neck Surg, 2014, 28(22):1762-1764.

相关文章 15

[1]	丁剑,刘艺鸣. 前庭康复对老年良性阵发性位置性眩晕患者后遗头晕的疗效[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 64-68.
[2]	孟立新,李健,韦善文. 鼓膜微管置入术治疗中耳不张76例临床分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 61-65.
[3]	吴湘萍. 患者管理方式对变应性鼻炎舌下含服粉尘螨滴剂疗效的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 68-72.
[4]	郝艳,李栋才,蓝建平. CO₂激光显微手术与传统显微手术切除声带息肉疗效比较[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 68-70.
[5]	鞠骏,李进让,邹世桢,贾曼玉. 创伤后良性阵发性位置性眩晕的临床特点及近期疗效研究[J]. 山东大学耳鼻喉眼学报, 2017, 31(5): 57-61.
[6]	周学义,李一鸣,王美菊,张苑苑,张历浊. 25+微创玻璃体视网膜手术治疗孔源性视网膜脱离的临床观察[J]. 山东大学耳鼻喉眼学报, 2017, 31(5): 92-94.
[7]	张晓莉,于泓,韩冬梅,杨瑞民,戚伟. 泪道激光联合引流管植入治疗泪道阻塞的临床观察[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 84-86.
[8]	朱琳,张德军,管国芳,郭颖媛. 显微镜联合耳内镜手术治疗岩尖巨大胆脂瘤一例[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 101-103.
[9]	屠燕怡,史丽,赵莉,金鹏,訾晓雪,李昂,金义炫,郅莉莉. 尘螨疫苗皮下注射治疗变应性鼻炎的疗效和安全性评估[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 50-55.
[10]	苏怡,谢景华,潘晓李,曾国庆. 慢性鼻-鼻窦炎伴或不伴鼻息肉患者鼻内镜手术的疗效及影响因素分析[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 86-89.
[11]	王戬, 葛前进, 康利萍. 鼓膜上皮皮瓣推移法修补边缘性鼓膜穿孔27例[J]. 山东大学耳鼻喉眼学报, 2015, 29(2): 15-16.
[12]	傅云春. 咽异感症患者心理因素评析及心理干预疗效分析[J]. 山东大学耳鼻喉眼学报, 2014, 28(6): 47-49.
[13]	孙新成, 卢国华, 陈晨, 谢阳. 顶端巩膜覆盖在羟基磷灰石义眼座植入术中的应用[J]. 山东大学耳鼻喉眼学报, 2014, 28(4): 87-89.
[14]	吴龙军1,2，黄益灯2，夏思文2. 耳内镜下自体脂肪鼓膜修补术疗效分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(6): 42-44.
[15]	刘春青，刘海成，侯峥. 耳内镜下治疗真菌性外耳道炎77例[J]. 山东大学耳鼻喉眼学报, 2013, 27(4): 51-52.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed