摘要:
目的 探讨总结鼓膜完整的传导性聋患者在耳内镜下行听骨链重建手术的疗效.方法 采用回顾性研究方法,收集2015年10月至2017年12月期间,在国内5家医院(四川大学华西医院、中国人民解放军总医院、上海交通大学医学院附属第九人民医院、空军军医大学西京医院和深圳市第六人民医院)因传导性聋收治住院行耳内镜下听骨链重建手术的45例患者的临床资料.男28例,女17例,年龄12~69岁.纳入患者术前检查鼓膜均完整,CT和术中探查仅发现单纯听骨链异常,排除耳硬化症、鼓室硬化症、中耳胆脂瘤、慢性化脓性中耳炎、中耳新生物等病例.观察分析本组患者在手术并发症、术后听力改善情况及手术时间等方面的特点.采用SPSS 23.0软件进行统计学分析.结果 本组患者术后未发生感音神经性聋,无面神经麻痹.7例患者术后出现一过性轻微耳鸣,随访期间逐渐缓解.9例患者术后发生味觉障碍.2例患者术后出现眩晕,但症状轻微,未进行特殊处理,1周内自行缓解.本组患者术前气骨导差范围为22.5 ~ 45.7 dB,平均气骨导差(25.3±8.6) dB.术后第3个月气骨导差范围为5.7 ~ 26.8 dB,平均气骨导差(9.3±8.6) dB.相对于术前,患者术后第3个月气骨导差平均值明显降低,差异具有统计学意义(t=2.31,P<0.05).各研究中心术者手术操作时长接近,均呈现先慢后快的趋势,平均手术时间为(43.56±18.25)min,各中心之间手术时长比较差异无统计学意义(F=3.26,P>O.05).结论 耳内镜下行听骨链重建手术的疗效较好.%Objective To explore the efficacy of ossiculoplasty surgery under oto-endoscope in patients of conductive hearing loss with intact tympanic membrane.Methods A retrospective study was conducted.The clinical data of 45 patients with conductive hearing loss who had undergone simple ossiculoplasty surgery between October 2015 and December 2017 from five hospitals in China (West China Hospital of Sichuan University,General Hospital of the People's Liberation Army,Shanghai Ninth People's Hospital,Shanghai JiaoTong University School of Medicine,Xijing Hospital,Fourth Military Medical University and Shenzhen Sixth People's Hospital) were collected.There were 28 males and 17 females,with the age ranging from 12 to 69 years old.The tympanic membranes of those patients were intact before surgery.The lesion only occurred in the ossicular chain from CT and intraoperative exploration.The cases of otosclerosis,tympanosclerosis,cholesteatoma of middle ear,chronic suppurative otitis media,and tumor of middle ear were excluded.The postoperative complications,hearing improvements and operation time were observed.SPSS 23.0 software was used for statistic analysis.Results There was neither sensorineural hearing loss nor facial paralysis after surgery in this group.Seven patients had transient mild tinnitus after surgery and gradually relieved during the follow-up period.Nine patients developed dysgeusia after surgery.Two patients developed dizziness after surgery,and the symptoms were mild and relieved during 1 week without special intervention.The air-bone gap (ABG) range of pre-operation was 22.5-45.7 dB,and the average ABG was (25.3±8.6) dB.The ABG range in the third month after surgery was 5.7-26.8 dB,and the average ABG was (9.3±8.6) dB.The mean value of ABG was significantly lower in the third month after surgery compared with that of pre-operation (t=2.31,P<0.05).The operation time of the surgeons in each research center was similar.The overall average of operation time was (43.56± 18.25) min.There was no significant difference in the duration of operation between the centers (F=3.26,P>0.05).Conclusion The ossiculoplasty surgery under oto-endoscope has good efficacy.