保留前缘的内窥镜软骨髓鞘成形术用于修复大面积前穿孔。

ShiQi Li, Xiaohua Li, Yuguang Li
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摘要

研究目的本研究比较了保留前缘的内窥镜软骨衬垫耳鸣成形术(IPAM)和软骨衬垫技术加鼓膜匝肌瓣(CUTF)修复前部大穿孔的移植效果和并发症。材料与方法:共招募了 55 名大型前穿孔患者,并将其分配到 IPAM 组(28 人)或 CUTF 组(27 人)。比较两组患者 12 个月后的移植成功率、听力增加、手术时间和术后并发症。结果显示IPAM 组和 CUTF 组的平均手术时间分别为 29.3 ± 2.7 分钟和 46.4 ± 3.9 分钟(P < .001)。IPAM 组的残余穿孔率为 0.0%,CUTF 组为 11.1%(P = .222)。所有患者都完成了为期 12 个月的随访。IPAM 组的总体移植物成功率为 96.4%,CUTF 组为 88.9%(P = .577)。在术后气导和骨导的纯音平均值、气-骨间隙 (ABG) 或 ABG 变化方面,两组之间没有观察到明显差异。在 CUTF 组中,22.2% 的患者报告味觉改变,3.7% 的患者出现骨性外耳道 (EAC) 狭窄,3.7% 的患者出现 EAC 胆脂瘤。相比之下,IPAM 组没有出现味觉改变、EAC 狭窄或胆脂瘤病例。结论使用 IPAM 和前软骨周折叠进行内窥镜软骨髓核成形术是一种简单、有效、微创的修复前方大穿孔的技术。与 CUTF 相比,它的移植成功率高,听力改善效果更好。
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Endoscopic Cartilage Myringoplasty with Anterior Margin Preservation for Repairing Large Anterior Perforations.

Objective: This study compared the graft outcomes and complications of endoscopic cartilage inlay myringoplasty with preservation of anterior margins (IPAM) and the cartilage underlay technique with raising the tympanomeatal flap (CUTF) for repairing large anterior perforations. Materials and Methods: In total, 55 patients with large anterior perforations were recruited and allocated to the IPAM (n = 28) or the CUTF (n = 27) group. The graft success rate, hearing gain, operation time, and postoperative complications were compared between the groups at 12 months. Results: The mean operation times were 29.3 ± 2.7 minutes and 46.4 ± 3.9 minutes in the IPAM and CUTF groups, respectively (P < .001). The residual perforation rate was 0.0% in the IPAM group and 11.1% in the CUTF group (P = .222). All patients completed the 12-month follow-up. The overall graft success rate was 96.4% in the IPAM group and 88.9% in the CUTF group (P = .577). No significant differences were observed between the groups in terms of postoperative pure-tone averages for air conduction and bone conduction, air-bone gaps (ABGs), or ABG changes. In the CUTF group, 22.2% of the patients reported altered taste perception, 3.7% experienced bony external auditory canal (EAC) stenosis, and 3.7% developed EAC cholesteatoma. By contrast, the IPAM group did not have any cases of altered taste perception, EAC stenosis, or cholesteatoma. Conclusions: Endoscopic cartilage myringoplasty with IPAM and anterior perichondrium folding is a simple, effective, and minimally invasive technique for repairing large anterior perforations. It offers a high graft success rate and better hearing improvement compared to CUTF.

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