山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (3): 27-30.doi: 10.6040/j.issn.1673-3770.1.2019.020

• 专家笔谈 • 上一篇    下一篇

耳内镜微创术——耳科手术的新途径

王登元,陈智斌(),邢光前   

  1. 南京医科大学第一附属医院 江苏省人民医院耳鼻咽喉科；世界卫生组织预防聋和听力减退合作中心；江苏省耳科疾病与听力障碍诊治中心，江苏 南京 210029
  • 收稿日期:2019-04-15 修回日期:2019-05-10 出版日期:2019-05-20 发布日期:2019-08-08
  • 通讯作者: 陈智斌 E-mail:chenzhibin@jsph.org.cn
  • 作者简介:陈智斌，临床医学博士，主任医师，副教授，硕士研究生导师。现任南京医科大学第一附属医院（江苏省人民医院）耳鼻咽喉科副主任，耳科与听力组组长；江苏省耳鼻咽喉科医疗质量控制中心副主任。主要学术任职：中华医学会耳鼻咽喉头颈外科学分会听力学组委员；江苏省医学会耳鼻咽喉头颈外科学分会常委，耳科与听力学组组长；江苏省防聋工作指导组副组长；江苏省残疾人康复协会第二届理事会理事；江苏省康复医学会听力语言康复专业委员会常委。从事耳鼻咽喉头颈外科工作 25年，主攻耳科学与听力学，发表学术论文20余篇。

Minimally invasive otoendoscopic surgery: a new path for ear surgery

Dengyuan WANG,Zhibin CHEN(),Guangqian XING   

  1.  Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University；WHO Collaborating Centre for the Prevention of Deafness and Hearing Impairment；Jiangsu Ear and Hearing Center, Nanjing 210029, Jiangsu, China
  • Received:2019-04-15 Revised:2019-05-10 Online:2019-05-20 Published:2019-08-08
  • Contact: Zhibin CHEN E-mail:chenzhibin@jsph.org.cn

RichHTML

30

PDF (PC)

1239

摘要：

综述了耳内镜外科手术的历史、优点和应用范围,以及存在的不足。与传统的显微镜手术比较，耳内镜具有高清、广角和放大等特点，手术视野更好，医生可经耳道完成更多种手术，避免在耳内或耳后切口，有望减少并发症，获得更好的手术效果。

关键词: 耳内镜, 耳外科手术, 治疗结局

Abstract:

This article reviews the history, advantages and disadvantages, and current applications of otoendoscopic ear surgery. The otoendoscopic approach has unique advantages over the microscopic approach; it allows the surgeon to visualize the surgical site more clearly from multiple angles and at various magnifications, enabling completion of procedures using the transcanal approach, thereby reducing the need for endoauricular or postauricular incisions and avoiding the associated morbidity. Otoendoscopes also reduce the rates of cholesteatoma recidivism in chronic ear surgery. Otoendoscopic ear surgery appears to be a promising new technique and a reliable alternative to traditional microscopic surgery.

Key words: Otoendoscopes, Otologic surgical procedures, Treatment outcome

中图分类号: 

  • R764.9
1 Nomura Y . Effective photography in otolaryngology-head and neck surgery: endoscopic photography of the middle ear[J]. Otolaryngol Head Neck Surg, 1982, 90(4): 395-398. doi:10.1177/019459988209000406 .
doi: 10.1177/019459988209000406
2 Thomassin JM , Duchon-Doris JM , Emram B , et al . Endoscopic ear surgery. Initial evaluation[J]. Ann Otolaryngol Chir Cervicofac, 1990, 107(8): 564-570.
3 邱建华, 乔莉, 陈福权, 等 . 耳内镜下上鼓室径路面神经水平段及膝状神经节减压术[J]. 临床耳鼻咽喉科杂志, 2002, 16(7): 338-339. doi:10.3969/j.issn.1001-1781.2002.07.007 .
doi: 10.3969/j.issn.1001-1781.2002.07.007
QIU Jianhua , QIAO Li , CHEN Fuquan , et al . Otoendoscopic tympanic segment and ganglion geniculi of facial nerve decompression via the attic approach[J]. Journal of Clinical Otorhinolaryngology, 2002, 16(7): 338-339. doi:10.3969/j.issn.1001-1781.2002.07.007 .
doi: 10.3969/j.issn.1001-1781.2002.07.007
4 Alicandri-Ciufelli M , Marchioni D , Kakehata S , et al . Endoscopic management of attic cholesteatoma: long-term results[J].Otolaryngol Clin North Am, 2016, 49(5):1265-1270. doi:10.1016/j.otc.2016.05.015
doi: 10.1016/j.otc.2016.05.015
5 Choi JE , Kim HJ , Kim BK , et al . Minimally invasive transcanal removal of attic cholesteatoma[J]. Korean J Otorhinolaryngol-Head Neck Surg, 2017, 60(4): 158-163. doi:10.3342/kjorl-hns.2016.17027 .
doi: 10.3342/kjorl-hns.2016.17027
6 Tseng CC , Lai MT , Wu CC , et al . Endoscopic transcanal myringoplasty for anterior perforations of the tympanic membrane[J]. JAMA Otolaryngol Head Neck Surg, 2016, 142(11): 1088-1093. doi:10.1001/jamaoto.2016.2114 .
doi: 10.1001/jamaoto.2016.2114
7 林枫, 王跃建, 虞幼军, 等 . 耳内镜辅助侧颅底和桥小脑角手术初探[J]. 听力学及言语疾病杂志, 2009, 17(6): 593-594. doi:10.3969/j.issn.1006-7299.2009.06.028 .
doi: 10.3969/j.issn.1006-7299.2009.06.028
8 汪照炎, 赵宇, 张秋航, 等 . 第六届国际耳内镜研讨会侧记[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(7): 544. doi:10.3760/cma.j.issn.1673-0860.2016.07.013 .
doi: 10.3760/cma.j.issn.1673-0860.2016.07.013
WANG Zhaoyan , ZHAO Yu , ZHANG Qiuhang , et al . Minutes of Ⅵ international workshop on endoscopic ear surgery[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2016, 51(7): 544. doi:10.3760/cma.j.issn.1673-0860.2016.07.013 .
doi: 10.3760/cma.j.issn.1673-0860.2016.07.013
9 高下, 戴艳红, 钱晓云, 等 . 耳内镜在耳科临床的应用[J]. 听力学及言语疾病杂志, 2005, 13(5): 369-370. doi:10.3969/j.issn.1006-7299.2005.05.022 .
doi: 10.3969/j.issn.1006-7299.2005.05.022
10 Pollak N . Endoscopic and minimally-invasive ear surgery: A path to better outcomes[J]. World J Otorhinolaryngol Head Neck Surg, 2017, 3(3): 129-135. doi:10.1016/j.wjorl.2017.08.001 .
doi: 10.1016/j.wjorl.2017.08.001
11 Preyer S . Endoscopic ear surgery-a complement to microscopic ear surgery[J]. HNO, 2017, 65(Suppl 1): 29-34. doi:10.1007/s00106-016-0268-x .
doi: 10.1007/s00106-016-0268-x
12 樊韵平, 夏文彤, 洪海裕, 等 . 鼓室成形术后主观味觉变化及术中鼓索神经不同处理方式的效果[J/OL]. 中华临床医师杂志(电子版), 2010, 4(9): 1612-1616. .
13 FAN Yunping , XIA Wentong , HONG Haiyu , et al . Subjective gustatory outcome in tympanoplasty and the strategy to protect Chorda tympani nerve[J/OL]. Chinese Journal of Clinicians(Electronic Version), 2010, 4(9): 1612-1616. .
14 杨海弟, 高敏倩, 熊浩, 等 . 耳内镜下中耳手术及鼓室成形术效果分析[J]. 中华耳科学杂志, 2017, 15(4): 403-407. doi:10.3969/j.issn.1672-2922.2017.04.003 .
doi: 10.3969/j.issn.1672-2922.2017.04.003
YANG Haidi , GAO Minqian , XIONG Hao , et al . Feasibility and efficacy of endoscopic middle ear surgery and tympanoplasty[J]. Chinese Journal of Otology, 2017, 15(4): 403-407. doi:10.3969/j.issn.1672-2922.2017.04.003 .
doi: 10.3969/j.issn.1672-2922.2017.04.003
15 Marchioni D , Mattioli F , Alicandri-Ciufelli M , et al . Endoscopic approach to tensor fold in patients with attic cholesteatoma[J]. Acta Otolaryngol, 2009, 129(9): 946-954. doi:10.1080/00016480802468187 .
doi: 10.1080/00016480802468187
16 Presutti L , Marchioni D , Mattioli F , et al . Endoscopic management of acquired cholesteatoma: our experience[J]. J Otolaryngol Head Neck Surg, 2008, 37(4): 481-487.
17 Sajjadi H . Endoscopic middle ear and mastoid surgery for cholesteatoma[J]. Iran J Otorhinolaryngol, 2013, 25(71): 63-70.
18 Sarcu D , Isaacson G . Long-term results of endoscopically assisted pediatric cholesteatoma surgery[J]. Otolaryngol Head Neck Surg, 2016, 154(3): 535-539. doi:10.1177/0194599815622441 .
doi: 10.1177/0194599815622441
19 Iannella G , Magliulo G . Endoscopic versus microscopic approach in stapes surgery: are operative times and learning curve important for making the choice? [J]. Otol Neurotol, 2016,37(9):1350-1357. doi： 10.1097/MAO. 00000-00000001186
doi: 10.1097/MAO. 00000-00000001186
20 Iannella G , Marcotullio D , Re M , et al . Endoscopic vs microscopic approach in stapes surgery: advantages in the middle ear structures visualization and trainee's point of view[J]. J Int Adv Otol, 2017, 13(1): 14-20. doi:10.5152/iao.2017.3322 .
doi: 10.5152/iao.2017.3322
21 赵宇, 郑永波, 娄麟, 等 . 耳内镜和显微镜下镫骨手术的比较[J]. 中华耳科学杂志, 2017, 15(4): 408-411. doi:10.3969/j.issn.1672-2922.2017.04.004 .
doi: 10.3969/j.issn.1672-2922.2017.04.004
ZHAO Yu , ZHENG Yongbo , LOU Lin , et al . A comparison of endoscopic and microscopic stapes surgeries[J]. Chinese Journal of Otology, 2017, 15(4): 408-411. doi:10.3969/j.issn.1672-2922.2017.04.004 .
doi: 10.3969/j.issn.1672-2922.2017.04.004
22 Orhan KS , Polat B , Çelik M , et al . Endoscopic-assisted cochlear implantation: a case series[J]. J Int Adv Otol, 2016, 12(3): 337-340. doi:10.5152/iao.2016.1636 .
doi: 10.5152/iao.2016.1636
23 Tarabichi M , Nazhat O , Kassouma J , et al . Endoscopic cochlear implantation: Call for caution[J]. Laryngoscope, 2016, 126(3): 689-692. doi:10.1002/lary.25462 .
doi: 10.1002/lary.25462
24 朱琳，张德军，管国芳,等 . 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):101-103,106. doi:10.6040/j.issn.1673-3770.0.2016.345
doi: 10.6040/j.issn.1673-3770.0.2016.345
ZHU Lin , ZHANG Dejun , GUAN Guofang , et al . Treatment of huge cholesteatoma in the petrous apex by microscope combined with otoendoscope: report of 1 case[J].J Otolaryngol Ophthal Shandong Univ, 2016,30(6):101-103,106. doi:10.6040/j.issn.1673-3770.0.2016.345
doi: 10.6040/j.issn.1673-3770.0.2016.345
25 汪照炎, 贾欢, 杨洁, 等 . 显微镜内镜联合技术在桥小脑角区手术中的应用[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(2): 85-88. doi:10.3760/cma.j.issn.1673-0860.2017.02.002 .
doi: 10.3760/cma.j.issn.1673-0860.2017.02.002
WANG Zhaoyan , JIA Huan , YANG Jie , et al . A combination use of endoscope and microscope in cerebral pontine angle surgery[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017, 52(2): 85-88. doi:10.3760/cma.j.issn.1673-0860.2017.02.002 .
doi: 10.3760/cma.j.issn.1673-0860.2017.02.002
26 赖彦冰, 虞幼军, 侯昭晖, 等 . 对耳内镜手术的思考[J]. 中华耳科学杂志, 2017, 15(4): 426-430. doi:10.3969/j.issn.1672-2922.2017.04.008 .
doi: 10.3969/j.issn.1672-2922.2017.04.008
LAI Yanbing , YU Youjun , HOU Zhaohui , et al . Deliberation on endoscopic ear surgery[J]. Chinese Journal of Otology, 2017, 15(4): 426-430. doi:10.3969/j.issn.1672-2922.2017.04.008 .
doi: 10.3969/j.issn.1672-2922.2017.04.008
27 Khan MM , Parab SR . Endoscopic septoplasty-two handed technique with endoscope holder: a novel approach[J]. Indian J Otolaryngol Head Neck Surg, 2016, 68(4): 475-480. doi:10.1007/s12070-016-0997-x .
doi: 10.1007/s12070-016-0997-x
28 Gardner EG , Sappington J , Arriaga MA , et al . Ultrasonic bone aspirator use in endoscopic ear surgery: feasibility and safety assessed using cadaveric temporal bones[J]. J Laryngol Otol, 2017, 131(11): 987-990. doi:10.1017/S0022215117001955 .
doi: 10.1017/S0022215117001955
29 Ozturan O , Dogan R , Eren SB , et al . Intraoperative thermal safety of endoscopic ear surgery utilizing a holder[J]. Am J Otolaryngol, 2018, 39(5): 585-591. doi:10.1016/j.amjoto.2018.07.001 .
doi: 10.1016/j.amjoto.2018.07.001
[1] 罗通勇,杨华清,岳胜清,贾全凡,袁龙. 帕尼单抗和紫杉醇一线治疗复发或转移性头颈肿瘤Ⅱ期患者效果观察[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 71-75.
[2] 张贵阳,黄河,冼志,张汉文,谢桂彩. 粉尘螨滴剂舌下含服免疫治疗对不同年龄段变应性鼻炎患者的临床效果评估[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 60-65.
[3] 钟晓声,杨海弟,郑亿庆. 突发性聋伴耳鸣的治疗与转归[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 43-46.
[4] 申宇鹏,宋琦,李晓明. 喉癌前病变的病因、分子机制和处理策略[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 25-30.
[5] 刘鸣. 早期声门癌的内镜治疗[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 6-9.
[6] 王登元,陈智斌,王杪琳. 伴发梅尼埃病的良性阵发性位置性眩晕的临床特点[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 61-65.
[7] 郎永耀,杨云,刘晴,徐林弟,林子萍. 咽喉反流性疾病的影响因素及治疗效果分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 119-123.
[8] 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.
[9] 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.
[10] 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.
[11] 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.
[12] 雷英，胡玥，张民，刘蓉蓉，尹艳丹，姬长友. 耳内镜下术腔清理联合应用超氧液对乳突根治术后创面修复的促进作用[J]. 山东大学耳鼻喉眼学报, 2012, 26(5): 36-37.
[13] 楚士东1，洪荧灿2，刘应万2，马纪清2，于振坤1. 耳内镜应用于外、中耳疾病258例[J]. 山东大学耳鼻喉眼学报, 2010, 24(3): 32-33.
[14] 肖辉良1，张伟华1，区永康2. 不同技术和材料在鼓膜修补术的应用[J]. 山东大学耳鼻喉眼学报, 2009, 23(6): 35-37.
[15] 岳耀光1 ，区永康2 ，许耀东2 ，张伟华1 ，肖辉良1
. 伴外耳道真菌病肉芽性鼓膜炎41例[J]. 山东大学耳鼻喉眼学报, 2009, 23(2): 50-52 .
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 林彬,王挥戈 . 功能性内镜鼻窦手术后鼻黏膜纤毛转归的研究[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 481 -487 .
[2] 张晗,黄一飞 . 抗角膜移植排斥的研究进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 84 -87 .
[3] 邓基波,孙奉乾,许安廷 . 大前庭导水管综合征[J]. 山东大学耳鼻喉眼学报, 2006, 20(2): 116 -118 .
[4] 陈文文 . 1例T/NK淋巴瘤17年演进[J]. 山东大学耳鼻喉眼学报, 2006, 20(5): 472 -472 .
[5] 周斌,李滨 . 鼻内窥镜下鼻窦鼻息肉手术75例疗效观察[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 24 -26 .
[6] 杨长亮,黄治物,姚行齐,诸勇,孙艺 . 正常气骨导听性脑干反应及其应用[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 9 -13 .
[7] 曹忠良 . 颌面复合伤155例临床分析[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 89 -89 .
[8] 牛善利,柴茂文,李振秀 . 鼻内镜下鼻甲成形术治疗慢性肥厚性鼻炎60例[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 16 -18 .
[9] 毕景云 . 鼻中隔矫正术后血肿的处理[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 90 -91 .
[10] 刘大昱,潘新良,雷大鹏,许风雷,张立强,栾信庸 . 梨状窝内侧壁癌的手术治疗[J]. 山东大学耳鼻喉眼学报, 2007, 21(1): 8 -11 .
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发