内镜下人工镫骨手术安全性和有效性的多中心研究

摘要

目的 分析内镜下人工镫骨手术的安全性并比较其与显微镜下手术有效性的差异.方法 回顾性分析2015年10月至2017年10月复旦大学附属眼耳鼻喉科医院等8家医院的137例耳硬化患者的临床资料.137例患者中行内镜人工镫骨植入手术88例,其中男29例,女59例;年龄29～66岁,平均(40.1±10.7)岁.137例患者中行显微镜下镫骨手术49例,其中男17例,女32例;年龄32～64岁,平均(38.7±9.2)岁.主要观察指标为:手术时间、术前、术后听力、术中情况、术后并发症.以SPSS 16.0软件进行统计学分析,组间比较采用t检验和x2检验.结果 内镜人工镫骨手术组平均手术操作时间(74.1±26.0) min,显微镜人工镫骨手术组(66.5±15.9) min,两组差异有统计学意义(t=1.279,P＜0.05).内镜人工镫骨手术组与显微镜人工镫骨手术组,最后10例平均手术操作时间均比最初10例时间短,差异有统计学意义(t值分别为3.028、3.610,P值均＜0.05).内镜人工镫骨手术组与显微镜人工镫骨手术组比较,术后气导听阈改善值(t=1.074,P=0.289)、气骨导差缩小值(t=-0.135,P=0.893)、高频骨导听阈改善值(t=1.222,P=0.228)差异均无统计学意义.内镜组与显微组术后并发面神经麻痹(均为0例)、鼓索损伤并味觉改变(6例比2例,x2=0.08,P＞0.05)、术后眩晕(18例比9例,x2=0.09,P＞0.05)差异无统计学意义.结论 内镜下人工镫骨手术安全,术后获得的听力学结果与显微镜下手术相似.%Objective To analyze the safety of endoscopic stapes surgery,and to compare the results with stapes surgery under microscopic approach.Methods This was a retrospective study.One hundred and thirty seven patients from Eye Ear Nose and Throat Hospital of Fudan University and other seven hospitals were enrolled in this study.Eighty eight patients,in whom 29 were male,and 59 were female,aged from 29 to 66 years old,with an average of 40.1 ± 10.7,underwent endoscopic stapedotomy and 49 patients,in whom 17 were male,and 33 were female,aged from 32 to 64 yeas old,with an arerage of 38.7 ± 9.2,underwent microscopic stapedotomy for otosclerosis.Interventions included endoscopic and microscopic stapes surgeries.Main outcome measures consisted of operating time,preoperative and postoperative hearing,intraoperative findings,and postoperative complications.SPSS 16.0 software was used to analyzed the date (t test and x2 test).Results Patients in the group who underwent endoscopic stapes surgery showed a mean operative time of (74.1 ±26.0) min.Patients in the group treated by microscopic approach had a mean operative time (66.5±15.9) min.Statistical difference was evident (t=1.279,P＜0.05).The average operative time of endoscopic surgery became shorter as the cases increased.The average duration of the last 10 cases was shorter than that of the first 10 cases in both groups.The differences were significant (t value was 3.028,3.610,both P ＜ 0.05).No statistical difference was found in air conduction threshold improvement (t=1.074,P=0.289),air-bone gap closure (t=-0.135,P=0.893) and bone conduction improvement (t=1.222,P=0.228) between the two groups.No difference regarding the incidence of the postoperative complications (chorda tympanum damage:6 cases vs 2 cases,x2=0.08,P＞0.05;vertigo:18 cases vs 9 cases,x2=0.09,P＞0.05;facial paralysis:0 case vs 0 case) between the two groups was found.Conclusion Audiological outcomes achieved by endoscopic surgery are similar to the results obtained through a microscopic approach.Endoscopic stapes surgery is safe.