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摘要: 目的 探讨耳内镜下经耳道处理鼓室硬化的可行性、手术方法和效果。方法 确诊为Ⅱ~Ⅳ型鼓室硬化症患者41例, 均行全耳内镜下手术。清除鼓室硬化灶, 并根据听骨情况行鼓室成形术。分别于术后1、3、6个月复查, 观察鼓膜愈合情况, 并以最后一次测试为最终听力结果, 比较鼓室硬化症不同分型以及不同鼓室成形术式间的术前术后气骨导差(ABG), 评价手术疗效。统计学分析采用SPSS 22.0。结果 术后43耳(97.7%)鼓膜一期完全愈合, 1耳遗留边缘性穿孔。术后均无并发症发生。术前ABG为(36.73±11.68) dB, 术后6个月ABG为(20.55±10.27) dB, 术前术后比较差异有统计学意义(t=20.476, P < 0.05)。鼓室硬化各型之间术前术后ABG比较差异无统计学意义。Ⅲ型的术后听力提高较Ⅱ型、Ⅳ型差, 但差异无统计学意义。Ⅱ型鼓室成形术后听力改善效果与Ⅲ型接近, 差异无统计学意义(P>0.05)。结论 耳内镜经外耳道手术处理鼓室硬化症是一种安全有效的手术方法, 近期效果满意, 远期疗效仍需进一步观察。Abstract: Objective To explore the feasibility of transcanal endoscopic ear surgery for tympanosclerosis as well as the surgical method and short-term effect.Method Forty-one patients with type Ⅱ-Ⅳ tympanosclerosis who underwent transcanal endoscopic ear surgery were retrospectively analysed. All the tympanosclerotic lesions were removed with endoscope, then tympanoplasty was performed according to the ossicular involvement. Postoperative examination and audiometry were performed at 1, 3 and 6 months after the operation. Pre-and post-operative(6 months as the final result) pure tone air-bone gap were compared between different types of tympanosclerosis to evaluate the short-term effect, the difference of hearing improvement between different type of tympanoplasties was also compared. SPSS 22.0 was used for statistical analysis.Result Forty-three ears recovered without complications, except one with marginal performation, the graft take rate was 97.7%. The preoperative and 6 months postoperative air-bone gap was (36.73±11.68) dB and (20.55±10.27) dB respectively, with significant difference(t=20.476, P < 0.05). There were no significant differences in hearing improvement among the three types, though the hearing improvement of Type Ⅲ typanosclerosis was worse than that of type Ⅱ and Ⅳ. There was no significant difference in the hearing improvement between type Ⅱ and Ⅲ tympanoplasty(P>0.05).Conclusion Transcanal endoscopic surgery is safe and effective for tympanosclerosis with satisfying short-term effect, though long-term result still needs further investigation.
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Key words:
- tympanosclerosis /
- endoscopic ear surgery /
- tympanoplasty
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表 1 不同鼓室硬化类型听力效果比较
鼓室硬化类型 耳数 气导阈值/dB HL 骨导阈值/dB HL ABG/dB 听力获益/dB 术前 术后 术前 术后 术前 术后 Ⅱ型 26 50.12±15.24 35.43±13.81 16.67±8.23 17.35±8.43 34.62±11.22 18.32±9.34 14.34±6.02 Ⅲ型 8 52.51±10.43 39.62±12.33 16.78±10.56 14.75±9.85 36.55±12.64 24.24±10.92 10.61±6.99 Ⅳ型 10 54.67±14.62 35.19±12.22 19.74±9.34 18.79±10.25 35.14±12.36 17.59±12.12 14.30±5.81 注：听力获益=术前ABG-术后ABG 
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表 2 不同手术方式听力效果比较
手术分类 耳数 气导阈值/dB HL 骨导阈值/dB HL ABG/dB 听力获益/dB 术前 术后 术前 术后 术前 术后 Ⅱ型鼓室成形术(PORP) 20 56.32±13.32 37.28±12.78 18.28±11.21 17.45±11.31 38.12±12.33 20.25±11.33 18.68±5.94 Ⅲ型鼓室成形术(软骨片加高) 18 54.17±15.99 35.56±14.33 20.73±12.54 18.14±11.65 34.73±11.45 17.62±10.41 17.34±6.05
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