耳内镜下鼓膜修补手术治疗湿耳期中耳炎的临床疗效分析

丁曌冉; 蒋成义; 王伟; 强化龙; 程忠强; 詹晓东

doi:10.16766/j.cnki.issn.1674-4152.001770

耳内镜下鼓膜修补手术治疗湿耳期中耳炎的临床疗效分析

doi: 10.16766/j.cnki.issn.1674-4152.001770

蚌埠医学院第一附属医院耳鼻咽喉头颈外科，安徽蚌埠 233004

基金项目:

安徽省高等学校省级质量工程项目 2017jyxm1398

详细信息

通讯作者:
詹晓东，E-mail：zxdent2007@aliyun.com

中图分类号: R764.21
计量
- 文章访问数: 489
- HTML全文浏览量: 215
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2020-07-01
- 网络出版日期: 2022-02-19

Analysis of clinical efficacy of tympanic membrane repair surgery under otoscope under wet ear stage

Department of Otolaryngology/Head and Neck Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨湿耳期慢性化脓性中耳炎单纯型患者行鼓膜修补术的临床疗效。方法对2018年9月—2019年12月在蚌埠医学院第一附属医院耳鼻咽喉头颈外科就诊的湿耳期中耳炎患者31例(31耳)进行回顾性研究，对比术前鼓膜穿孔情况及听力丧失程度，对术后3个月患者听力恢复情况、鼓膜愈合情况及患者满意度进行分析，探讨在临床工作中，湿耳期的慢性化脓性中耳炎患者是否可行耳内镜下鼓膜修补手术，以及手术是否能获得满意的疗效。结果除1例患者术后3个月复查见鼓膜再穿孔外，其余患者(30/31，96.77%)术后3个月鼓膜均愈合良好；所有患者的术后听力与术前对比均得到明显提高，平均气导听阈由术前的(38.45±1.65)dB HL在术后3个月恢复至(25.94±2.62)dB HL；平均气骨导听阈差由术前的(23.68±1.17)dB HL在术后3个月恢复至(7.77±1.78)dB HL，差异有统计学意义(均P＜0.05)。患者总体满意人数达到30例(96.77%)。结论在术前及术中对外耳道及鼓室内脓性分泌物妥善清理，同时术前和术后根据药敏结果合理使用抗生素的情况下，湿耳期的慢性化脓性中耳炎患者可施行耳内镜下鼓膜修补手术，并可得到满意的临床疗效。
- 慢性化脓性中耳炎 /
- 鼓膜修补 /
- 湿耳 /
- 耳内镜
Abstract: Objective To investigate the clinical effect of tympanoplasty in patients with chronic suppurative otitis media in wet ear stage. Methods A retrospective study was conducted on 31 patients with otitis media in wet ear stage who were treated in the Department of Otolaryngology, head and neck surgery, the First Affiliated Hospital of Bengbu Medical College from September 2018 to December 2019. The degree of tympanic membrane perforation and hearing loss before operation were compared, and the hearing recovery, tympanic membrane healing and patients' satisfaction three months after operation were analyzed. Whether the patients with chronic suppurative otitis media in wet ear stage can be operated with tympanic membrane repair under otoscope in clinical work, and whether the operation can obtain satisfactory curative effect were discussed. Results All the patients (30/31 ears) had good tympanic membrane healing at 3 months after operation, except that 1 patient showed perforation of tympanic membrane. The postoperative hearing of all patients was significantly improved compared with that before surgery, and the mean air-to-air hearing threshold recovered from (38.45±1.65) dB HL before surgery to (25.94±2.62)dB HL 3 months after surgery. The mean gas-bone conduction threshold difference recovered from (23.68±1.17) dB HL before surgery to (7.77±1.78) dB HL 3 months after surgery, with statistically significant difference (all P < 0.05). The overall satisfaction of patients reached 30(96.77%). Conclusion Under the condition of proper cleaning of purulent secretions in the external auditory canal and the drum chamber before and during the operation, and rational use of antibiotics according to drug sensitivity results before and after the operation, Otoscopic tympanoplasty can be performed in patients with chronic suppurative otitis media in the wet ear stage, with satisfactory clinical efficacy.
- Chronic suppurative otitis media /
- Tympanic membrane repair /
- Wet ear /
- Otoscope

HTML全文

图 1 慢性化脓性中耳炎患者耳内镜下表现

注：可见鼓膜中央部大穿孔，鼓室内可见少许脓性分泌物。

下载: 全尺寸图片幻灯片

图 2 鼓膜修补术后3个月耳内镜下图片

注：鼓膜表面未见异常脓性分泌物，未见明显充血。鼓膜生长良好，无明显穿孔。

下载: 全尺寸图片幻灯片

图 3 患者术前及术后3个月纯音听阈测定比较

注：术耳为右耳。通过对比明显可见患者右耳气导听阈及气骨导听阈差均明显下降。

下载: 全尺寸图片幻灯片

表 1 慢性化脓性中耳炎患者术前术后听力情况(x ±s，dB HL)

时间	平均气导听阈	平均气骨导听阈差
术前	38.45±1.65	23.68±1.17
术后3个月	25.94±2.62	7.77±1.78
t值	8.183	16.214
P值	＜0.001	＜0.001

下载: 导出CSV

参考文献(20)

[1]	黄选兆, 汪吉宝, 孔维佳, 等. 实用耳鼻咽喉头颈外科学[M]. 2版. 北京: 人民卫生出版社, 2018: 888.
[2]	韩宇, 张昌明, 凤娅妮, 等. 不同鼓室黏膜状态的湿耳施行鼓室成形术的疗效分析[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(2): 100-105. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202002002.htm
[3]	JAMES A L. Endoscope or microscope-guided pediatric tympanoplasty? Comparison of grafting technique and outcome[J]. Laryngoscope, 2017, 127(11): 2659-2664. doi: 10.1002/lary.26568
[4]	SEN A, ÖZDAMAR K. Which graft should be used for the pediatric transcanal endoscopic type 1 tympanoplasty?A comparative clinical study[J]. Int J Pediatr Otorhinolaryngol, 2019, 121: 76-80. doi: 10.1016/j.ijporl.2019.02.046
[5]	COHEN M S, LANDEGGER L D, KOZIN E D, et al. Pediatric endoscopic ear surgery in clinical practice: Lessons learned and early outcomes[J]. Laryngoscope, 2016, 126(3): 732-738. doi: 10.1002/lary.25410
[6]	冀庆军, 柴伟, 黄辉等. 耳内镜与显微镜下夹层法修补鼓膜大穿孔的疗效比较[J]. 听力学及言语疾病杂志, 2020, 28(1): 92-94. doi: 10.3969/j.issn.1006-7299.2020.01.025
[7]	凡启军, 倪丽艳, 项松洁, 等. 耳内镜与显微镜下鼓膜成形术的临床疗效比较[J]. 中国内镜杂志, 2018, 24(10): 34-38. doi: 10.3969/j.issn.1007-1989.2018.10.006
[8]	李慧林, 张志飞, 谢马先, 等. 耳内镜与耳显微镜下鼓膜成形术的差异性比较[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(13): 1021-1024. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201713013.htm
[9]	廖麒, 王伟, 强化龙, 等. 耳内镜下3种耳屏软骨技术在鼓膜修补中的临床应用[J]. 当代医学, 2019, 25(7): 33-36. doi: 10.3969/j.issn.1009-4393.2019.07.014
[10]	李霞, 徐龙, 王丹. 耳内镜微创手术在治疗不同原因所致鼓膜破裂的临床疗效和安全性[J]. 中华全科医学, 2020, 18(3): 400-402. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202003017.htm
[11]	阮开安, 吴铖林, 张武宁. 耳内镜下夹层法鼓膜成形术治疗鼓膜大穿孔的临床研究[J]. 中国内镜杂志, 2020, 26(2): 60-64. doi: 10.3969/j.issn.1007-1989.2020.02.012
[12]	徐继峰, 李巍. 耳内镜下耳屏软骨-软骨膜修补鼓膜大穿孔临床疗效[J]. 中国医学文摘(耳鼻咽喉科学), 2020, 35(1): 43-45. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYEB202001015.htm
[13]	SHARMA Y, MISHRA G, PATEL J V. Comparative study of outcome of type I tympanoplasty in chronic otitis media active mucosal disease (Wet Ear) versus chronic otitis media inactive mucosal disease (Dry Ear)[J]. Indian J Otolaryngol Head Neck Surg, 2017, 69(4): 500-503. doi: 10.1007/s12070-017-1233-z
[14]	杨文, 赵宇, 娄麟, 等. 干湿耳条件下耳内镜鼓膜修补术近期疗效的前瞻性对照研究[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(10): 874-878. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202010003.htm
[15]	SANTOSH U P, PRASHANTH K B, RAO M S. Study of myringoplasty in wet and dry ears in mucosal type of chronic otitis media[J]. J Clin Diagn Res, 2016, 10(9): 1-3. http://www.researchgate.net/profile/Uttarkar_Santosh/publication/309115128_Study_of_Myringoplasty_in_Wet_and_Dry_Ears_in_Mucosal_Type_of_Chronic_Otitis_Media/links/5804801b08ae23fd1b68a6b6/Study-of-Myringoplasty-in-Wet-and-Dry-Ears-in-Mucosal-Type-of-Chronic-Otitis-Media.pdf
[16]	NADERPOUR M, SHAHIDI N, HEMMATJOO T. Comparison of tympanoplasty results in dry and wet ears[J]. Iran J Otorhinolaryngol, 2016, 28(86): 209-214. http://www.sid.ir/en/VEWSSID/J_pdf/86120168602.pdf
[17]	LOU Z, LI X. A comparative study of endoscopic cartilage myringoplasty used to treat wet and dry ears with mucosal-type chronic otitis media[J]. J Laryngol Otol, 2020. DOI: 10.1017/S0022215120001486.
[18]	邸远志, 闫辉, 周雪芳, 等. 耳内镜下Ⅰ型鼓室成形干湿耳手术199例疗效观察[J]. 中国处方药, 2019, 17(10): 145-146. doi: 10.3969/j.issn.1671-945X.2019.10.087
[19]	柴伟, 李大鹏, 徐甜甜, 等. 湿耳与干耳条件下行Ⅰ型鼓室成形术后鼓膜愈合率的差异及鼓膜残缘的病理特点[J]. 中国耳鼻咽喉颅底外科杂志, 2020, 26(2): 185-187. https://www.cnki.com.cn/Article/CJFDTOTAL-ZEBY202002019.htm
[20]	任远, 王凯. 中耳炎鼓膜小穿孔耳内镜治疗的研究[J]. 中国耳鼻咽喉头颈外科, 2020, 27(3): 141-144. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT202003008.htm