王昌阳　　慈军　　吴萼　　管骅

[关键词] 中耳炎;活动期;耳内镜;鼓膜修补术

[中图分类号] R749.6          [文献标识码] B          [文章编号] 1673-9701（2021）16-0091-05

Clinical effect of ear endoscopic tympanic membrane repair in active phase of chronic suppurative otitis media

WANG Changyang1   CI Jun1   WU E2   GUAN Hua1

1.Department of Otorhinolaryngology， Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine， Hangzhou 310000， China; 2.Medical College of Hangzhou Normal University， Hangzhou   310002， China

[Abstract] Objective To investigate the clinical effect of ear endoscopy on tympanic membrane repair in the active phase of chronic suppurative otitis media. Methods Twenty-seven patients in the active stage of chronic suppurative otitis media who were admitted to Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine from April 2018 to April 2019 were selected as the study group and were treated with ear endoscopic tympanic membrane repair. Twenty-seven patients in the same period were selected as the control group and ear endoscopic tympanic membrane repair was performed after ear drying. The tympanic membrane healing， air-bone gaps and complications were compared between the two groups. Results The good rate of tympanic membrane healing in the study group （88.89%） was higher than that in the control group （66.67%）， and the difference between the two groups was statistically significant （P<0.05）. After operation， the air-bone gaps were decreased in both groups， and （12.5±1.4）dB HL in the study group was lower than （17.9±3.7）dB HL in the control group， the difference between the two groups was statistically significant（P<0.05）. No postoperative complications such as dizziness and decreased taste were found in both groups. Conclusion For patients in the active phase of chronic suppurative otitis media， the therapeutic effect of ear endoscopic tympanic membrane repair is clear， which is worth popularizing.

[Key words] Otitis media; Active phase; Ear endoscope; Tympanic membrane repair

慢性化膿性中耳炎作为耳科常见疾病，其临床症状主要有耳内反复流脓、听力下降，长期进展可引起不可逆性听力下降、眩晕、面瘫，严重者可危及生命。传统观点认为，慢性化脓性中耳炎一期鼓膜修补术需干耳后行手术治疗。随着技术的进步，国内外学者进行了相关的前瞻性及回顾性研究，发现鼓膜愈合率及听力改善程度与鼓室内是否有炎性病变无明显相关性[1-2]。本研究2018年4月至2019年4月对27例慢性化脓性中耳炎活动期病例在耳内镜下行鼓膜修补术，现报道如下。

1 资料与方法

1.1 一般资料

浙江省中西医结合医院耳鼻咽喉科2018年4月至2019年4月收治27例（27耳）慢性化脓性中耳炎活动期患者作为研究组，男7例、女20例，年龄19～81岁，平均（51.2±3.8）岁，病史1～20年，平均（10.2±2.6）年;穿孔直径：>5 mm者9例，3～5 mm者15例，<3 mm者3例;穿孔部位：中央型穿孔22例、边缘性穿孔5例;病变情况：2例仅剩鼓环，5例鼓室内肉芽组织堵塞，20例鼓膜紧张部穿孔，鼓室黏膜充血，鼓室可见黏稠或脓性分泌物。选取同期27例（27耳）患者作为对照组，男5例、女22例，年龄18～80岁，平均（50.7±3.7）岁，病史1～21年，平均（10.6±2.7）年;穿孔直径：>5 mm者8例，3～5 mm者16例，<3 mm者3例;穿孔部位：中央型穿孔20例，边缘性穿孔7例;病变情况：1例仅剩鼓环，7例鼓室内肉芽组织堵塞，19例鼓膜紧张部穿孔，鼓室黏膜充血，鼓室可见黏稠或脓性分泌物。本次研究经相关伦理委员会批准，且签署知情同意书。

慢性化脓性中耳炎活动期的诊断标准[3]：长期耳流脓史，伴听力下降。鼓膜紧张部或松弛部穿孔，鼓室黏膜水肿或有肉芽增生。

纳入标准：①慢性化脓性中耳炎活动期，单耳发病;②内镜检查提示鼓膜紧张部穿孔;③鼓室黏膜充血，鼓室可见黏稠或脓性分泌物;④纯音听阈检查提示传导性耳聋或混合性耳聋，气骨导差距<30 dB HL。

排除标准：①合并胆脂瘤组织及胆固醇肉芽肿;②合并慢性中耳炎等出现充血水肿者;③拒绝参与或中途退出者。

1.2 方法

研究组：手术均在全麻下进行，同一术者完成，常规消毒铺巾后……