【北京同仁医院】鼓室成形术

耳内镜下中耳手术及鼓室成形术效果分析杨海弟;高敏倩;熊浩;梁茂金;郑亿庆【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 dB HL,术后3个月平均气导听阈30.59±12.16 dB HL,听力提高程度具有统计学意义(P<0.001).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.%Objective To investigate the feasibility and efficacy of endoscopic tympanoplasty. Methods This was a retrospective study including 42 patients with chronic suppurative otitis, attic cholesteatoma or tympanosclerosis who received endoscopic tympanoplasty. Graft success rate and audiometric improvement after surgery were assessed. Re-sults The overall graft take rate was 95.2%(40/42). Perforation in two cases were completely healed after additional en-doscopic treatment in the outpatient office. Mean air-bone gap before surgery was 52.32 ± 14.70 dB and improved to 30.59±12.16 dB after surgery (P<0.001). Partial flap necrosiswas seen in 3 cases and recovered after appropriate treat-ment. There were no complications such as severe sensoneural hearing loss, facial paralysis or vertigo. Conclusions Our study demonstrates that endoscopic tympanoplasty can be effectively applied in middle ear surgery, including for cases of attic cholesteatoma. A better view of the middle ear can be acquired during endoscopic surgery compared to micro-scopic surgery, facilitating preservation of non-diseased structures. In addition, endoscopic surgery requires smaller inci-sions and less medical expenditures and provides better hearing improvement. Although endoscopic middle surgery car-ries promises in the future, disadvantages such as single-hand operation need to be overcome.【期刊名称】《中华耳科学杂志》【年(卷),期】2017(015)004【总页数】5页(P403-407)【关键词】耳内镜;鼓室成形术;可行性;术后效果【作者】杨海弟;高敏倩;熊浩;梁茂金;郑亿庆【作者单位】中山大学孙逸仙纪念医院耳鼻喉科广州510120;中山大学孙逸仙纪念医院耳鼻喉科广州510120;中山大学孙逸仙纪念医院耳鼻喉科广州510120;中山大学孙逸仙纪念医院耳鼻喉科广州510120;中山大学孙逸仙纪念医院耳鼻喉科广州510120【正文语种】中文【中图分类】R764Science and Technology Planning Project of Guangdong Province（2013B02200051）;Guangzhou science and technology program livelihood projects（2014Y2-00511）Declaration of interest:The authors report no conflicts of interest.自1992年手术显微镜问世后，耳显微外科发展迅速，显微镜下的一系列中耳手术在清除病灶、获得干耳及提高听力方面已经取得很好效果，显微镜下鼓室成型已十分成熟，术者可依据不同疾病而选择多种术式，但对中耳功能结构的保留却还不够完善[1]。

义（p>0.05）。

各鼓室成形术术后二周低频听力改善均较高频听力显著（p<0.01）。

术后平均听阈提高值与年龄、病程、呈微弱负相关性，与性别、鼓膜穿孔面积以及MERI值无明显相关性。

结论不伴乳突根治术的鼓室成形术对中耳增益效应影响显著，能较好的改善术后听力，低频听力改善较为显著。

鼓室成形术后短期手术疗效与年龄、病程、性别、鼓膜穿孔面积及MERI值无显著相关性。

关键词鼓室成形术,中耳增益机制,MERI值ANALYSIS OF HEARING RESULTS AFTERTYMPANOPLASTY--A STUDY ON THE PRESSURE GAINS AND OTHERFACTORSABSTRACTObjective: The aim of this study was to compare the acoustic pressure gained in different tympanoplasty.Study Design: Retrospective review of patient records.Subjects and methods: The charts of 137 patients who underwent different tympanoplasty operations were reviewed. They were divided into three groups. The hearing outcomes after two weeks, 1 year and 5 years were analyzed. Nonparametric statistics was used to determine group differences. A probability value of p<0.05 was the level of significance selected. Prognostic factors such as age, sex, size of perforation, duration of medical history and middle ear risk index were investigated.Results: Significance better hearing results were observed in thetympanoplasty without mastoidectomy group, which is similar to those of the myringoplasty group, especially on the lower frequencies. There was no significant correlation between the hearing outcomes and factors such as age, sex, size of perforation, duration of medical history and middle ear risk index.Conclusion: The tympanoplasty without mastoidectomy is a useful surgical technique as far as the hearing results are concerned. The type of operation is found to be a significant independent prognostic factor.KEY WORDS: tympanoplasty，acoustic pressure gain，middle ear risk index缩略词表toneaverage 平均听阈PTA PureABG Air-bone gap 气骨导差MERI Middle Ear Risk Index 中耳危险指数CWU Canal wall up 完壁式鼓室成形术CWD Canal wall down 开放式鼓室成形术上海交通大学学位论文原创性声明本人郑重声明：所呈交的学位论文，是本人在导师的指导下，独立进行研究工作所取得的成果。

鼓膜大穿孔耳内镜下鼓膜成形术的临床报告周卫东;袁媛;王玲;李辉【摘要】目的探讨对鼓膜大穿孔病例应用耳内镜下单纯鼓膜成形术的疗效.方法选取2015年9月-2018年1月收治的鼓膜大穿孔患者43例(46耳),耳内镜下采取耳屏软骨-软骨膜进行鼓膜成形术,对鼓膜愈合及听力情况进行评价.结果 43耳鼓膜愈合,3耳未愈合,愈合率93.5％,听力改善患者满意,1例出现迟发性面瘫,药物治疗后恢复,其余均无并发症出现.结论耳内镜下应用耳屏软骨-软骨膜修补鼓膜大穿孔操作相对简单,能抵近观察,手术成功率高,比显微镜下手术更具优势,利于年轻医师上手,值得临床推广.【期刊名称】《中国内镜杂志》【年(卷),期】2019(025)007【总页数】4页(P73-76)【关键词】鼓膜穿孔;内镜;鼓膜成形术【作者】周卫东;袁媛;王玲;李辉【作者单位】江苏省无锡市人民医院耳鼻咽喉科,江苏无锡 214023;江苏省无锡市人民医院耳鼻咽喉科,江苏无锡 214023;江苏省无锡市人民医院耳鼻咽喉科,江苏无锡 214023;江苏省无锡市人民医院耳鼻咽喉科,江苏无锡 214023【正文语种】中文【中图分类】R764鼓膜成形术是临床常开展的耳显微手术，以往主要在显微镜下进行，但在部分鼓膜大穿孔的患者或外耳道前壁骨质突出的情况下，经常会使术者难以清晰地看清穿孔前缘，放置植入物时无法准确定位，导致手术不成功。

本科2015年9月起开始在耳内镜下进行取耳屏软骨-软骨膜来修补鼓膜大穿孔43例（46耳），取得满意疗效。

现报道如下：1 资料与方法1.1 一般资料收集2015年9月－2018年1月我院收治的鼓膜大穿孔患者43例（46耳）。

其中，男30例，女13例，3例为双耳，年龄21～67岁。

其中，外伤原因5耳，慢性中耳炎导致41耳，均为鼓膜大穿孔，穿孔直径大于5.0 mm，干耳35耳，潮湿耳9耳，2耳有少许脓性物。

术前纯音测听（500 Hz、1 000 Hz、2 000 Hz 和4 000 kHz），平均气导听阈为40～50 dBHL，气骨导差为20～40 dBHL之间。