Clinical study on repairing subtotal perforation of tympanic membrane with cartilage island technique combined with palisade technique under otoscope
-
摘要: 目的 探讨耳内镜下软骨岛技术结合栅栏软骨技术修补鼓膜次全穿孔的鼓膜愈合率。方法 回顾性分析2018年1月—2020年1月湖南省人民医院耳鼻咽喉头颈外科收治的慢性化脓性中耳炎患者189例，分为高年资耳科医师组(组1)和低年资耳科医师组(组2)。组1(100例)分为2个亚组：A组单用软骨岛技术完成68例，B组采用软骨岛技术结合栅栏软骨技术32例；组2(89例)分为2个亚组：C组单用软骨岛技术50例，D组采用软骨岛技术结合栅栏软技术39例。结果 组1鼓膜愈合率为96.0%(96/100)，组2为87.6%(78/89)，两组间鼓膜愈合率差异有统计学意义(χ2=4.504，P=0.034)。A组鼓膜愈合率为94.1%(64/68)，B组为100%(32/32)，C组为80.0%(40/50)，D组为97.4%(38/39)。其中A组与B组比较差异无统计学意义(χ2=1.961，P=0.161)，C组与D组比较差异有统计学意义(χ2=6.149，P=0.013)，A组与C组比较差异有统计学意义(χ2=5.492，P=0.019)，B组与D组比较差异无统计学意义(χ2=0.832，P=0.362)。结论 对于初学鼓膜成形术的术者，耳内镜下采用软骨岛技术结合栅栏软骨技术能明显提高鼓膜次全穿孔鼓膜成形术的成功率。Abstract: Objective To investigate the healing rate of subtotal perforation of tympanic membrane repaired by cartilage island technique combined with palisade cartilage technique under otoscope.Methods A retrospective analysis was performed on 189 patients with chronic suppurative otitis media who were admitted to the Department of Otolaryngology and Head and Neck Surgery of Hunan Provincial People's Hospital from January 2018 to January 2020. The patients were divided into twogroups, in group onethere were 100 patients treated by senior surgeon, which were divided into two subgroups, Group A (68 cases) were treated with cartilage island technique alone, and Group B (32 cases) were treated with cartilage island technique combined with palisade cartilage technique. In group two there were 89 patients treated by junior surgeons, which were divided into two subgroups. In group C, 50 cases were treated with cartilage island technique alone, and in group D, 39 cases were treated with cartilage island technique combined with palisade cartilage technique.Results The healing rate of tympanic membrane in group 1 was 96.0% (96/100), and in group 2 was 87.6%(78/89).There was statistically significant in group 1 and group 2(χ2=4.504, P=0.034).The healing rate of tympanic membrane was 94.1% (64/68) in group A, 100%(32/32)in group B, 80.0%(40/50) in group C, and 97.4% (38/39) in group D. There was no statistically significant difference between group A and group B (χ2=1.961, P=0.161), there was statistically significant difference between group C and group D (χ2=6.149, P=0.013), and there was statistically significant difference between group A and group C(χ2=5.492, P=0.019)There was no statistical difference between group B and group D(χ2=0.832, P=0.362).Conclusion For beginners of tympanoplasty, the use of cartilage island technique combined with palisade cartilage technique in otoscope can significantly improve the success rate of tympanoplasty with subtotal tympanic perforation.
-
Key words:
- myringoplasty /
- cartilage island technique /
- palisade cartilage technique /
- otoscope
-
-
图 1 软骨岛； 图 2 栅栏状软骨； 图 3 软骨岛技术结合栅栏软骨技术修补鼓膜次全穿孔术前、术中及术后6个月 3a：术前耳内镜下右耳鼓膜次全穿孔；3b：术中耳内镜下软骨岛结合栅栏软骨修补鼓膜后即刻(白色箭头示软骨岛，黑色箭头示栅栏软骨)；3c：术后6个月鼓膜(白色箭头示软骨岛，黑色箭头示栅栏软骨)； 图 4 软骨岛修补鼓膜术前、术中及术后6个月耳内镜 4a：术前耳内镜下右耳鼓膜次全穿孔；4b：术中耳内镜下软骨岛修补鼓膜后即刻图(白色箭头示软骨岛)；4c：术后6个月鼓膜(白色箭头示软骨岛)。
表 1 组1与组2听力情况比较
x±s，dB 组别 AC术前 ABG术后 AC术后 ABG术后 组1 43.23±8.89 14.43±3.25 34.88±8.59 6.87±6.11 组2 42.47±8.35 15.29±3.82 35.26±9.35 6.29±3.73 t 0.602 -1.675 -0.298 0.794 P 0.548 0.096 0.766 0.429 
下载: 导出CSV
表 2 A组与B组听力情况比较
x±s，dB 组别 AC术前 ABG术前 AC术后 ABG术后 A组 42.60±8.67 14.02±3.35 34.45±8.03 6.61±5.06 B组 44.56±9.34 15.28±2.89 35.78±9.75 7.40±7.95 t -1.028 -1.815 -0.669 -0.600 P 0.307 0.073 0.506 0.550
下载: 导出CSV
表 3 C组与D组听力情况比较
x±s，dB 组别 AC术前 ABG术前 AC术后 ABG术后 C组 42.10±8.07 15.38±3.80 35.70±10.21 6.10±3.68 D组 42.94±8.78 14.07±2.64 34.71±8.20 6.53±3.83 t -0.473 1.822 0.489 -0.548 P 0.637 0.072 0.626 0.585
下载: 导出CSV
-
[1] van Stekelenburg B, Aarts M. Determinants influencing success rates of myringoplasty in daily practice: a retrospective analysis[J]. Eur Arch Otorhinolaryngol, 2019, 276(11): 3081-3087. doi: 10.1007/s00405-019-05611-5
[2] Onal K, Uguz MZ, Kazikdas KC, et al. A multivariate analysis of otological, surgical and patient-related factors in determining success in myringoplasty[J]. Clin Otolaryngol, 2005, 30(2): 115-120. doi: 10.1111/j.1365-2273.2004.00947.x
[3] Peng R, Lalwani AK. Efficacy of "hammock" tympanoplasty in the treatment of anterior perforations[J]. Laryngoscope, 2013, 123(5): 1236-1240. doi: 10.1002/lary.23747
[4] Bayram A, Bayar Muluk N, Cingi C, et al. Success rates for various graft materials in tympanoplasty-A review[J]. J Otol, 2020, 15(3): 107-111. doi: 10.1016/j.joto.2020.01.001
[5] Darouassi Y, Aljalil A, Ennouali A, et al. Prognostic factors of myringoplasty: study of a 140 cases series and review of the literature[J]. Pan Afr Med J, 2019, 33: 323.
[6] 张瑾, 汪照炎, 杨琼, 等. 耳内镜下鼓膜成形术临床疗效分析的多中心回顾性研究[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(4): 245-250.
[7] Jalali MM, Motasaddi M, Kouhi A, et al. Comparison of cartilage with temporalis fascia tympanoplasty: A meta-analysis of comparative studies[J]. Laryngoscope, 2017, 127(9): 2139-2148. doi: 10.1002/lary.26451
[8] Dornhoffer JL. Cartilage tympanoplasty[J]. Otolaryngol Clin North Am, 2006, 39(6): 1161-1176. doi: 10.1016/j.otc.2006.08.006
[9] Visvanathan V, Vallamkondu V, Bhimrao SK. Achieving a Successful Closure of an Anterior Tympanic Membrane Perforation: Evidence-Based Systematic Review[J]. Otolaryngol Head Neck Surg, 2018, 158(6): 1011-1015. doi: 10.1177/0194599818764335
[10] Yang T, Wu X, Peng X, et al. Comparison of cartilage graft and fascia in type 1 tympanoplasty: systematic review and meta-analysis[J]. Acta Otolaryngol, 2016, 136(11): 1085-1090. doi: 10.1080/00016489.2016.1195013
[11] Tos M. Cartilage tympanoplasty methods: proposal of a classification[J]. Otolaryngol Head Neck Surg, 2008, 139(6): 747-758. doi: 10.1016/j.otohns.2008.09.021
[12] Anschuetz L, Stricker D, Yacoub A, et al. Acquisition of basic ear surgery skills: a randomized comparison between endoscopic and microscopic techniques[J]. BMC Med Educ, 2019, 19(1): 357. doi: 10.1186/s12909-019-1803-8
[13] Wasson JD, Papadimitriou CE, Pau H. Myringoplasty: impact of perforation size on closure and audiological improvement[J]. J Laryngol Otol, 2009, 123(9): 973-977. doi: 10.1017/S0022215109004368
[14] Applebaum EL, Deutsch EC. An endoscopic method of tympanic membrane fluorescein angiography[J]. Ann Otol Rhinol Laryngol, 1986, 95(5 Pt 1): 439-443.
[15] Barake R, El Natout T, Bassim M, et al. Loop underlay tympanoplasty for anterior, subtotal and total tympanic membrane perforations: a retrospective review[J]. J Otolaryngol Head Neck Surg, 2019, 48(1): 12. doi: 10.1186/s40463-019-0335-x
-
图(1)
表(3)
计量
- 文章访问数: 906
- PDF下载数: 168
- 施引文献: 0