耳内镜下颞肌筋膜四点固定法鼓膜修补术的临床疗效
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北京大学第三医院院临床重点项目(BYSY2017025,BYSYZD2021015)。


Clinical effect of four-point fixation endoscopic myringoplasty with temporal muscle fascia
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    摘要:

    目的 探讨采用耳内镜下颞肌筋膜"四点固定法"修补鼓膜穿孔,观察其临床疗效。方法 选取北京大学第三医院耳鼻咽喉科2020年12月-2021年6月因鼓膜紧张部前方或中央型大穿孔的患者19例随机分为两组。观察组10例(12耳),行耳内镜下"四点固定法"鼓膜修补术,注意下方鼓沟表面、锤骨柄内侧面、后方鼓沟与鼓索神经表面及前上部鼓环与鼓沟之间的裂隙四处关键点的固定;对照组9例(9耳),采用带软骨膜的耳屏软骨进行耳内镜下鼓膜修补术。所有患者术后3个月分别采用耳内镜及纯音听力检查进行客观评估,采用汉化版苏黎世慢性中耳炎量表(ZCMEI)对患者进行中耳炎症状、术后主观听力水平、社会心理影响及医疗资源进行生活质量评估。结果 观察组12耳术后2周穿孔基本愈合,鼓膜的形态更接近于正常浅凹型。穿孔修复成功率100%;对照组有1例前方遗留裂隙样穿孔,穿孔修复成功率88.9%。采用"四点固定法",术后听力PTA(22.5±7.5)dB,ABG(10.0±8.2)dB,较术前的(35.1±12.6)dB和(21.7±8.2)dB有明显提高(P=0.009,P=0.011)。与对照组相比,观察组在0.25、0.5、1 kHz上术后气导较术前有显著性提高,而对照组仅在0.25 kHz处有显著性提高。生活质量评分两组在中耳炎症状、术后主观听力水平、社会心理影响及医疗资源占用四个维度的评分上无明显差异(P>0.05)。结论 耳内镜下采用颞肌筋膜"四点固定法"修补鼓膜,可以获得很高的修复成功率,且术后鼓膜形态更接近于自然的鼓膜形态,术后听力改善效果好,对于耳道宽敞、位于前方边缘的穿孔及对术后听力改善要求高的病例,可采用此方法进行鼓膜修补手术。

    Abstract:

    Objective To explore a novel method of "four-point fixation" endoscopic myringoplasty with temporal muscle fascia and its clinical efficacy.Methods A total of 19 patients with large anterior or central perforation of tympanic membrane underwent endoscopic myringoplasty at the Peking University Third Hospital from Oct 2020 to June 2021 were included. and divided into two groups. In observation group, 12 ears (10 cases) were repaired with temporal muscle fascia via "four-point fixation" method, and 9 ears (9 cases) in the control group with tragus cartilage with perichondrium under endoscope. Objective evaluation was carried out by endoscopy and pure tone audiometry 3 months postoperatively. Chinese version of the Zurich Chronic Middle Ear Invertory (ZCMEI) was used to evaluate the quality of life of the two groups from four aspects, including otitis media symptoms, postoperative subjective hearing level, psychosocial impact and medical resources occupation.Results The graft success rate was 100% in the observation group, and the shape of eardrum was closer to normal shallow concave shape. In the control group, the success rate was 88.9% with front fissure perforation in one case. In the observation group, the postoperative pure tone average (PTA) and air-bone gap (ABG) were (22.5±7.5) dB and (10.0±8.2) dB respectively, which were significantly higher than the preoperative ones[(35.1±12.6) dB and (21.7±8.2)dB,(P=0.009, P=0.011)]. The postoperative air conductances of the observation group at 0.25 k, 0.5 k and 1 kHz were significantly improved, while the postoperative air conductance was significantly improved only at 0.25 kHz in the control group. In terms of quality of life score, there were no significant differences between the two groups in otitis media symptoms, postoperative subjective hearing level, psychosocial impact and medical resource occupation (P>0.05).Conclusion With advantages of high graft success rate, natural shape of the postoperative eardrum and good hearing improvement, "four-point fixation" endoscopic myringoplasty with temporal muscle fascia can be used for tympanic membrane repair in patients with large ear canal, anterior tympanic membrane perforation and high requirement for postoperative hearing improvement.

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柯嘉,熊姗,许尧珂,杜雅丽,马芙蓉.耳内镜下颞肌筋膜四点固定法鼓膜修补术的临床疗效[J].中国耳鼻咽喉颅底外科杂志,2021,27(6):630-635

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  • 收稿日期:2021-11-23
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  • 在线发布日期: 2022-01-06
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