目的 咽鼓管球囊扩张术(Balloon Eustachian tuboplasty, BET)的主要方式是采用经鼻腔入路将导管插入咽鼓管口,但是对于鼻腔明显狭窄的患者手术存在一定难度.因此我们采用一种新的导管推进器经口腔来完成BET手术,本研究的目的是探讨两种手术方式的特点及术后效果.方法 经患者同意后入组咽鼓管功能障碍患者41名,其中女性26名、男性15名,年龄在14至58岁之间,平均年龄47岁.将入组病例随机分为两组.一组患者采用经鼻腔入路行BET手术,另一组患者在70度鼻内镜下采用新型经口导管行经口入路手术.分别对两组患者的手术时间、术中出血等级、尝试插入导管次数和出现导管折曲次数等参数进行记录和对比.两种入路的术后效果评价方法是采用咽鼓管评分系统(Eustachian tube score ,ETS),通过对比患者术前术后的ETS分值变化来判断术后咽鼓管功能的恢复情况.结果 全部41名患者共完成64例咽鼓管球囊扩张术,经鼻组患者20名共行29例手术,经口组患者21名共行35例手术.除经鼻组病例中出现一例术后少量鼻出血之外,无其他手术并发症出现.经鼻组平均手术时间为621秒,经口入路组为484秒,两组间有显著统计学差异(P=0.012).经鼻组患者术中成功插入导管所需的平均尝试次数为2.15次,而经口组患者中有22例术中只需一次尝试就成功插入导管.两组间一次性插入成功率和平均尝试次数均存在显著统计学差异(P<0.05).在术中发生导管折曲的次数(经鼻组7例,经口组6例)和球囊移位次数(经鼻组3例,经口组1例)在两组间也有显著统计学差异(P<0.05).术后随访6个月,所有患者的ETS分值较术前都有显著提高(P<0.01).经鼻组患者的ETS分值从术前的3.43±2.47提高到7.16±2.72.经口组患者从2.65±2.87提高到6.16 ±3.72.经统计学分析显示采用不同手术入路的两组患者在术后早期效果方面尚无统计学差异(P>0.05).结论 鼻内镜下经口入路行咽鼓管球囊扩张术是一种新的手术方法.相比经鼻入路手术,它具备手术时间更短,术中出血少,一次置入的成功率较高且未增加任何手术风险等优势,尤其适合鼻腔解剖异常的患者.经口入路操作更简单,易于初学者掌握.%Objective The main procedure of Balloon Eustachian Tuboplasty(BET)is inserting catheter into Eustachian tubeostium through nasal cavity, but there is some difficulty in the operation of patients with obvious deviated nasal septum. Therefore, we used a different way to perform BET surgery with a new catheter insertion tool. The aim of this study was to assess the characteristics and postoperative effects of the two surgical approaches about Balloon Eustachian tuboplasty. Methods After informed consent, 41 patients (26 females, 15 males) with eustachian tube dysfunction were enrolled in the study, aged from 14 to 58 with an average age of 47 years. All patients were randomly divided into two groups. One group of patients underwent BET surgery through nasal cavity, and the other group performed the surgery under 70°endoscope with a new catheter insertion tool via oral approach. The duration of the overall procedure, intraoperative bleeding grade, number of attempts and catheter kinking were recorded and compared. Main outcome measures were based on the Eustachian tube score (ETS) by comparing the changes of ETS scores perioperatively to estimate the recovery of postoperative Eustachian tube funtion. Result All 41 patients underwent 64 BET procedures, while the trans-nasal group of 20 patients underwent 29 cases and the trans-oral group received 35cases. Only one minor nasal bleeding complication occurred in nasal group. The overall mean duration of the procedure was 621 seconds in trans-nasal group and 484 seconds in trans-oral group, with statistically significant differences between the two groups(P=0.012). The mean number of attempts to complete the procedure was 2.15 in trans-nasal group, while 22 cases of the trans-oral group required no repeat attempts. There was a significant statistical difference in the success rate of one-off insertion and average number of attempts among the two groups (P<0.05).The number of catheter kinking (7 cases in trans-nasal group Vs 6 cases in trans-oral group ) and balloon displacement (3 cases in trans-nasal group Vs 1 case in trans-oral group) revealed a statistically significant difference(P<0.05). Six months after the procedure, the Eustachian Tube Score of all patients including the R-values and tympanogram showed a statistically positive outcome (P<0.01). The average Eustachian tube score improved from 3.43 ±2.47 to 7.16 ±2.72 in trans-nasal group and improved from 2.65 ±2.87 to 6.16±3.72 in trans-oral group. Subjective improvement was seen in 76% in trans-nasal group and 81% in trans-oral group. There was no significant difference in early outcome between the two groups (P>0.05). Conclusion Endoscopic trans-oral Eustachian tube balloon dilation is a novel surgical method. This study demonstrates that trans-oral approach has the several advantages including shorter duration of the procedure, less intraoperative bleeding and higher success rate of one insertion than trans-nasal approach, and no significant adverse effects are encountered. Therefore, the new skill is readily acquired by first-time surgeons.
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