摘要目的 探讨耳内镜下经外耳道鼓膜成形术的临床疗效.方法 回顾性分析我国8家三级甲等医院临床中心自2016年6月至2017年6月行耳内镜下鼓膜成形术的523例慢性中耳炎患者的临床资料,其中男256例,女267例;年龄18～68岁.术中常规取耳屏软骨-软骨膜复合物修补鼓膜.分别于术后1、3、6、9、12个月复查,至少随访3个月以上.分别比较不同影响因素下鼓膜穿孔愈合率,术前与术后3个月听力改善程度、术后并发症的发生率.采用SPSS 21.0软件对数据进行统计学分析.结果 523例患者术后3个月,鼓膜紧张部穿孔前下、下方、后方、近全穿孔的穿孔愈合率分别为92.4％(109/118)、94.9％(93/98)、95.6％(129/135)、89.0％(153/172),差异无统计学意义(x2=5.779,P=0.123).鼓膜小、中、大穿孔的穿孔愈合率分别为100.0％(82/82)、93.7％(178/190)、89.2％(224/251),差异有统计学意义(x2=10.927,P=0.004).干耳、湿耳鼓膜穿孔愈合率分别93.1％(392/421)、90.2％(92/102),差异无统计学意义(x2=1.011,P=0.915).术前与术后3个月平均气导听阈分别为(38.4±5.3)dBHL、(25.1±5.7)dBHL,差异有统计学意义(t=39.079,P＜0.001);术前与术后3个月平均气骨导差分别为(22.4±4.3)dB、(9.1±3.8)dB,差异有统计学意义(t=53.004,P＜0.001).523例患者术后并发中耳感染14例(2.7％),鼓膜位置异常8例(1.5％),味觉异常12例(2.3％),耳鸣35例(6.7％),听力下降28例(5.4％),眩晕26例(5.0％),再穿孔33例(6.3％),继发胆脂瘤2例(0.4％),无面神经麻痹并发症发生.结论 耳内镜下鼓膜成形术是一种安全有效的手术方法 .

abstractsObjective To analyze the therapeutic effect of endoscopic myringoplasty.Methods A retrospective analysis of 523 patients with chronic otitis media who underwent endoscopic myringoplasty between June 2016 and June 2017 in eight tertiary hospitals in China.Among all the patients,256 were male and 267 were female,aged from 18 to 68 years old.The grafts used to repair the tympanic membrane were all tragus cartilage-perichondrium complex.All patients were followed up at 1 month,3 months,6 months,9 months,and 12 months after surgery,at least 3 months.The closure rate of tympanic membrane perforation by different factors,the hearing results,and the incidence of postoperative complications were analyzed.SPSS 21.0 software was used to analyze the data.Results Three months after operation,the closure rates of anterior,inferior,posterior and subtotal perforation were 92.4％ (109/118),94.9％ (93/98),95.6％ (129/135),and 89.0％ (153/172) respectively,the difference was not statistically significant (x2=5.779,P=0.123).The closure rates of small,medium and large perforations were 100.0％ (82/82),93.7％ (178/190) and 89.2％ (224/251) respectively.The difference was statistically significant (x2=10.927,P=0.004).The closure rates of dry ear and wet ear tympanic membrane perforation were 93.1％ (392/421),90.2％ (92/102),the difference was not statistically significant (x2=1.011,P=0.915).The preoperative pure tone audiometry(PTA) was (38.4± 5.3) dBHL,while,the 3-month postoperative PTA was (25.1±5.7) dBHL.The difference was statistically significant (t=39.079,P＜0.001).The preoperative air bone gap (ABG) was (22.4±4.3) dB,while 3 months postoperative ABG was (9.1 ±3.8) dB.The difference was statistically significant (t=53.004,P＜0.001).Of all 523 patients,14 (2.7％) had middle ear infection,8 (1.5％) had dislocated tympanic membrane,12 (2.3％) had parageusia,35 (6.7％) had tinnitus,28(5.4％) had hearing loss,26 (5.0％) had vertigo,33 (6.3％) had reperforation,2 (0.4％) had secondary cholesteatoma,and none had facioplegia.Conclusions Endoscopic myringoplasty is a safe and effective surgical method with good postoperative outcome.