耳内镜下鼓膜修补术与显微镜下鼓膜修补术的对比观察(1)
[摘要] 目的 比较耳内镜下鼓膜修补术与显微镜下鼓膜修补术的效果。 方法 分析中国人民解放军空军军医大学第一附属医院西京医院2016年1月～2017年12月耳鼻喉咽喉-头颈外科手术室收治的200例鼓膜穿孔患者临床资料，依据手术方式不同进行分组，耳内镜下鼓膜修补术组100例和显微镜下鼓膜修补术组100例。观察比较两组鼓膜修补术患者术中出血量、手术时间、术后疼痛分级、术后听力提高水平、手术总有效率、住院天数和并发症发生率情况。 结果 两组鼓膜修补术患者术中出血量、手术时间、术后听力提高水平和手术总有效率比较，差异均无统计学意义(P > 0.05)；耳内镜下鼓膜修补术组患者术后疼痛分级优于显微镜下鼓膜修补术组，住院天数少于显微镜下鼓膜修补术组，并发症发生率低于显微镜下鼓膜修补术组，差异有统计学意义(P < 0.05)。 结论 耳内镜下鼓膜修补术治疗鼓膜穿孔，疼痛感小，恢复快，并发症少，值得临床推广应用。
[关键词] 耳内镜下鼓膜修补术；显微镜下鼓膜修补术；鼓膜穿孔；对比
[中图分类号] R764 [文献标识码] A [文章编号] 1673-7210(2018)08(c)-0117-04
[Abstract] Objective To compare the effecacy of otoendoscope myringoplasty and microscope myringoplasty. Methods The clinical data of 200 cases of tympanic membrane perforation patients treated in Department of Otolaryngology-Head and Neck Surgery， Xijing Hospital， the First Affiliated Hospital of the Fourth Military Medical University of PLA， from January 2016 to December 2017 were analyzed. They were divided into two groups by different operation method， with 100 cases in otoendoscope myringoplasty group and 100 cases in microscope myringoplasty group. The peroperative bleeding， operation time， pain grading post operation， improvement of hearing level post operation and total effective rate， hospital stay and complication incidence of the two groups were compared. Results The peroperative bleeding， operation time， hearing level post operation and total effective rate of the two groups had no significant difference (P > 0.05). The pain grading post operation of otoendoscope myringoplasty group was better than microscope myringoplasty group， the hospital stay was less than microscope myringoplasty group， and complication incidence rate was lower than microscope myringoplasty group， the differences were statistically significant (P < 0.05). Conclusion The otoendoscope myringoplasty treatment for tympanic membrane perforation patient， the pain is little， the recovery is quick， the complication is few， and it is worth to be promoted.
[Key words] Otoendoscope myringoplasty； Microscope myringoplasty； Tympanic membrane perforation； Comparison
中耳炎屬于耳鼻喉常见疾病，其容易侵犯中耳，对鼓室、鼓窦、咽鼓管和乳突等组织结构造成炎性浸润，属于中耳黏膜、鼓膜化脓性炎性反应[1-2]。鼓膜穿孔作为中耳炎常见的并发症，其发生因素比较复杂，临床表现为听力降低、耳鸣、流脓和耳闷等[3-4]。耳内镜下鼓膜修补术与显微镜下鼓膜修补术属于临床常用的鼓膜穿孔治疗方式[5-6]。临床上采用何种修补术式，提高鼓膜修补术临床效果，降低患者疼痛感成为耳鼻咽喉-头颈外科研究的热点问题。本研究通过对中国人民解放军空军军医大学第一附属医院西京医院(以下简称“我院”)耳鼻喉咽喉-头颈外科手术室收治的200例鼓膜穿孔患者临床资料进行分析，拟探讨耳内镜下鼓膜修补术与显微镜下鼓膜修补术的治疗效果，现将结果报道如下：
1 资料与方法
1.1 一般资料
选取我院2016年1月～2017年12月耳鼻喉咽喉-头颈外科手术室收治的200例鼓膜穿孔患者临床资料进行分析，依据手术方式不同进行分组，耳内镜下鼓膜修补术组100例，男56例，女44例；年龄19～57岁，平均(40.5±9.9)岁；病程1～8 d，平均(3.3±1.5)d。显微镜下鼓膜修补术组100例，男52例，女48例；年龄21～59岁，平均(41.4±10.2)岁；病程1～7 d，平均(3.0±1.3)d。纳入标准：①患者主诉耳内有反复性的脓性分泌物，并且伴有听力减退，在不同部位可能有鼓膜穿孔的化脓性中耳炎；②鼓膜紧张部有不同程度的穿孔，中耳干燥时间>1个月，患耳鼓室黏膜表面稍微有湿润，中耳内壁没有复层鳞状上皮化；③上鼓室和听骨链没有明显的病变，咽鼓管的功能状态良好；④通过听力检查，结果显示主要是传导性耳聋。排除标准：胆脂瘤型中耳炎后引起的听力降低；耳廓畸形、外耳道闭锁患者；全聋、重度的感音神经性聋患者；分泌性中耳炎患者、突发性耳聋患者、梅尼埃病患者；近期颅脑外伤后出现的中耳病变患者；糖尿病患者；高血压控制效果不佳、凝血功能障碍者。两组一般资料差异无统计学意义(P > 0.05)，具有可比性。本研究在医院医学伦理委员会批准下进行，患者在知情同意下参与本研究。, http://www.100md.com(刘红 付宝花 温立婷)
[关键词] 耳内镜下鼓膜修补术；显微镜下鼓膜修补术；鼓膜穿孔；对比
[中图分类号] R764 [文献标识码] A [文章编号] 1673-7210(2018)08(c)-0117-04
[Abstract] Objective To compare the effecacy of otoendoscope myringoplasty and microscope myringoplasty. Methods The clinical data of 200 cases of tympanic membrane perforation patients treated in Department of Otolaryngology-Head and Neck Surgery， Xijing Hospital， the First Affiliated Hospital of the Fourth Military Medical University of PLA， from January 2016 to December 2017 were analyzed. They were divided into two groups by different operation method， with 100 cases in otoendoscope myringoplasty group and 100 cases in microscope myringoplasty group. The peroperative bleeding， operation time， pain grading post operation， improvement of hearing level post operation and total effective rate， hospital stay and complication incidence of the two groups were compared. Results The peroperative bleeding， operation time， hearing level post operation and total effective rate of the two groups had no significant difference (P > 0.05). The pain grading post operation of otoendoscope myringoplasty group was better than microscope myringoplasty group， the hospital stay was less than microscope myringoplasty group， and complication incidence rate was lower than microscope myringoplasty group， the differences were statistically significant (P < 0.05). Conclusion The otoendoscope myringoplasty treatment for tympanic membrane perforation patient， the pain is little， the recovery is quick， the complication is few， and it is worth to be promoted.
[Key words] Otoendoscope myringoplasty； Microscope myringoplasty； Tympanic membrane perforation； Comparison
中耳炎屬于耳鼻喉常见疾病，其容易侵犯中耳，对鼓室、鼓窦、咽鼓管和乳突等组织结构造成炎性浸润，属于中耳黏膜、鼓膜化脓性炎性反应[1-2]。鼓膜穿孔作为中耳炎常见的并发症，其发生因素比较复杂，临床表现为听力降低、耳鸣、流脓和耳闷等[3-4]。耳内镜下鼓膜修补术与显微镜下鼓膜修补术属于临床常用的鼓膜穿孔治疗方式[5-6]。临床上采用何种修补术式，提高鼓膜修补术临床效果，降低患者疼痛感成为耳鼻咽喉-头颈外科研究的热点问题。本研究通过对中国人民解放军空军军医大学第一附属医院西京医院(以下简称“我院”)耳鼻喉咽喉-头颈外科手术室收治的200例鼓膜穿孔患者临床资料进行分析，拟探讨耳内镜下鼓膜修补术与显微镜下鼓膜修补术的治疗效果，现将结果报道如下：
1 资料与方法
1.1 一般资料
选取我院2016年1月～2017年12月耳鼻喉咽喉-头颈外科手术室收治的200例鼓膜穿孔患者临床资料进行分析，依据手术方式不同进行分组，耳内镜下鼓膜修补术组100例，男56例，女44例；年龄19～57岁，平均(40.5±9.9)岁；病程1～8 d，平均(3.3±1.5)d。显微镜下鼓膜修补术组100例，男52例，女48例；年龄21～59岁，平均(41.4±10.2)岁；病程1～7 d，平均(3.0±1.3)d。纳入标准：①患者主诉耳内有反复性的脓性分泌物，并且伴有听力减退，在不同部位可能有鼓膜穿孔的化脓性中耳炎；②鼓膜紧张部有不同程度的穿孔，中耳干燥时间>1个月，患耳鼓室黏膜表面稍微有湿润，中耳内壁没有复层鳞状上皮化；③上鼓室和听骨链没有明显的病变，咽鼓管的功能状态良好；④通过听力检查，结果显示主要是传导性耳聋。排除标准：胆脂瘤型中耳炎后引起的听力降低；耳廓畸形、外耳道闭锁患者；全聋、重度的感音神经性聋患者；分泌性中耳炎患者、突发性耳聋患者、梅尼埃病患者；近期颅脑外伤后出现的中耳病变患者；糖尿病患者；高血压控制效果不佳、凝血功能障碍者。两组一般资料差异无统计学意义(P > 0.05)，具有可比性。本研究在医院医学伦理委员会批准下进行，患者在知情同意下参与本研究。, http://www.100md.com(刘红 付宝花 温立婷)