Evaluation of the feasibility of endoscopic tympanoplasty in two-person three-hand operation
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摘要: 目的 研究双人三手操作耳内镜与显微镜下鼓室成形术对慢性化脓性中耳炎患者术后疗效的差异，探讨双人三手操作耳内镜的优势与不足。方法 回顾性研究2019年4月—2023年3月在湖南省人民医院耳鼻咽喉头颈外科接受鼓室成形术的100例患者，根据随机数字表法将其分为2组，各50例。其中接受双人三手耳内镜下鼓室成形术50例(A组)，行常规显微镜下鼓室成形术50例(B组)，对2组患者的手术及术后情况进行随访。结果 A组手术平均时间为(65.78±18.21) min、术中平均出血量为(12.94±4.46) mL、术后疼痛评分为(1.82±0.6)分、术后平均住院时间为(2.76±0.72) d；B组手术平均时间为(89.45±20.38) min、术中平均出血量为(22.78±5.74) mL、术后疼痛评分为(2.98±0.85)分、术后平均住院时间为(3.82±0.75) d，2组比较差异均有统计学意义(P＜0.05)。2组患者术后6个月听力均有明显提高，术前、术后比较差异均有统计学意义(P＜0.05)，但术前、术后6个月2组间指标比较，差异均无统计学意义(P>0.05)。术中并发鼓索神经损伤A组2例(4%)，B组1例(2%)，差异无统计学意义(P＞0.05)。A组术后鼓膜一次性愈合情况共47例(94%)，B组48例(96%)，差异无统计学意义(P＞0.05)。结论 双人三手操作耳内镜下鼓室成形术治愈率、听力改善情况与常规显微镜手术无明显差异，手术用时明显缩短、出血量更少、术后恢复更快，其具有术野清晰、双手操作、微创等优点，可覆盖中耳鼓窦及乳突范围，手术并发症低，值得推广。Abstract: Objective To study the difference of postoperative efficacy between two-person three-hand ear endoscopy and microscopic tympanoplasty in patients with chronic suppurative otitis media, and to explore the advantages and disadvantages of two-person three-hand ear endoscopy.Methods A retrospective study was conducted on 100 patients who underwent tympanoplasty in the Department of Otolaryngology and Head and Neck Surgery of Hunan People's Hospital from April 2019 to March 2023, and they were divided into 2 groups with 50 cases each according to random number table method. Among them, 50 cases underwent endoscopic tympanoplasty in two-person three-hand(group A) and 50 cases underwent routine microscopic tympanoplasty(group B). The operation and postoperative conditions of the two groups were followed up.Results In group A, the mean operation time was(65.78±18.21) min, the mean intraoperative blood loss was(12.94±4.46) mL, the postoperative pain score was(1.82±0.60) points, and the mean postoperative hospital stay was(2.76±0.72) d. The mean operation time of group B was(89.45±20.38) min, the mean intraoperative blood loss was(22.78±5.74) mL, the postoperative pain score was(2.98±0.85) points, and the mean postoperative hospital stay was(3.82±0.75) d, which with statistical significance between the two groups(P < 0.05). Hearing in both groups was significantly improved 6 months after surgery, and the difference was statistically significant before and after surgery(P < 0.05), but there was no significant difference between the two groups before surgery and 6 months after surgery(P>0.05). There were 2 cases in group A(4%) and 1 case in group B(2%) complicated with tympanic cord injury during operation, and the difference was not statistically significant(P > 0.05). There were 47 cases of A group(94%) of one-time healing of tympanic membrane after operation, 48 cases(96%) of group B, and the difference was not statistically significant(P > 0.05).Conclusion There is no significant difference in cure rate and hearing improvement between two-person three-hand ear endoscopic tympanoplasty and conventional microscope surgery, and the operation time is significantly shortened, the amount of blood loss is less, and the postoperative recovery is faster. It has the advantages of clear operating field, two-person three-hand operation, minimally invasive, and can reach the range of middle ear tympanic sinus and mastoid apex, and the surgical complications are seldom, which is worth promoting.
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Key words:
- otoscope /
- chronic otitis media /
- two-person three-hand operation
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表 1 2组患者手术指标比较
组别 手术时间/min 术中出血/mL 术后疼痛评分 平均住院时间/d A组 65.78±18.21 12.94±4.46 1.82±0.60 2.76±0.72 B组 89.45±20.38 22.78±5.74 2.98±0.85 3.82±0.75 t 6.064 9.474 7.799 7.109 P ＜0.001 ＜0.001 ＜0.001 ＜0.001 
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表 2 各组术前术后平均气导听阈
dB HL 组别 术前 术后 t P A组 50.33±12.21 30.57±9.64 22.317 ＜0.001 B组 52.88±12.03 31.16±9.05 19.747 ＜0.001 t 1.042 0.313 P 0.301 0.755
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表 3 各组术后气骨导差值
dB HL 组别 术前 术后 t P A组 27.35±6.53 18.04±3.72 10.481 ＜0.001 B组 27.76±5.79 17.86±4.21 13.150 ＜0.001 t 0.327 0.229 P 0.744 0.819
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