1.新疆维吾尔自治区人民医院;2.People'3.'4.s Hospital of Xinjiang Uygur Autonomous Region,Urumqi,Xinjiang,830000;5.China
摘 要：目的 探讨耳内镜与显微镜下Ⅰ型鼓室成形术，在治疗鼓膜穿孔患者手术疗效，分析随访资料。方法 纳入2017年1月～2020年10月因慢性化脓性中耳炎行Ⅰ型鼓室成形术的的122例（122耳）患者，耳内镜下Ⅰ型鼓室成形术(ETT)组62例和显微镜下Ⅰ型鼓室成形术(MTT)组60例。术后随访至少6月，比较两组术中出血量、鼓索神经损伤率、手术时间、术后出院时间、住院费用，鼓膜愈合情况，手术前和术后6月的平均气导听阈（PTA），气骨导差(ABG)进行分析，采用视觉模拟评分（VAS）评估术后24小时疼痛反应。结果 ETT组具有术中出血量少、手术时间短、术后疼痛反应轻、出院时间缩短、住院总费用少等优越性，两组差异显著（P<0.05）。ETT和MTT组中鼓膜愈合率分别为：93.5%和90%，鼓索神经损伤率分别为6.5%和8.3%，两组术前PTA分别为（43.2±11.3）和（45.6±12.1）dB，AGB 分别为（19.8±8.6）和（21.3±9.4）dB。术后6个月PTA两组均以降低，分别为（33.7±8.3）dB和（35.3±9.1）dB。 ABG缩小，分别为（9.4±6.1）dB，和（10.7±6.4）dB。两组差异无统计学意义（P＞0.05）。结论 与MTT相比，ETT明显减轻术后疼痛、缩短手术时间、住院时间，减少总住院费。在术后穿孔修补、听力改善以及并发症等方面与传统手术MTT疗效相当，值得在中耳手术中推广使用。
Abstract: Objective To investigate the surgical effects of Endoscopic and Microscopic type I tympanoplasty, and to conduct clinical follow-up analysis. Methods The study subjects included 122 patients（122ears） with chronic suppurative otitis media in our department from January 2017 to October 2020. 62 patients in the Endoscopic type I tympanoplasty（ETT） group and 60 patients in the Microscopic type I tympanoplasty (MTT) group. The postoperative follow-up period was at least 6 months, and the intraoperative bleeding, Chorda tympani nerve injury rate, operation time, postoperative discharge time, total hospitalization expenses , graft success rate，average air conduction hearing threshold（PTA）, air-bone gap(ABG) pre and post-operatively and The visual analogue score(VAS) 42h postoperatively were compared between the two groups. Results Compared with the microscope group,the ETT group had the advantages of less intraoperative blood loss, shorter operation time, light postoperative pain response, and short discharge time, and less total hospitalization expenses (P<0.05) . The graft success rates in the ETT and MTT groups were 93.5% and 90%. Intraoperative Chorda tympani nerve injury rates were 6.5% and 8.3%, respectively. The preoperative PTA of the two groups were (43.2±11.3) and (45.6±12.1) dB, The AGB is (19.8±8.6) and (21.3±9.4) dB, respectively. At 6 months after the operation, the PTA of the two groups decreased, which were (33.7±8.3) dB and (35.3±9.1) dB, respectively. The ABG reduction is (9.4±6.1) dB and (10.7±6.4) dB respectively. The difference between the two groups were not statistically significant (P>0.05).Conclusion Compared with MTT, ETT significantly reduces postoperative pain, shortens operation time, hospital stay, and reduces total hospital expenses. The postoperative perforation repair, hearing improvement and complications are equivalent to traditional MTT surgery, and it is worthy of popularization in middle ear surgery.