用内窥镜软骨片加固技术修复伴有前管壁突出的前穿孔。

Xionghui Hu, Fang-Luo Md, Di-He Md, Wenlong Jiang
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摘要

目的评估内镜下软骨片加固技术用于前缘穿孔修补术伴前管壁突出的效果和并发症。材料和方法:我们对 2017 年 2 月 1 日至 2023 年 8 月 29 日期间使用内窥镜软骨切片加固技术治疗的 38 例前穿孔伴前管壁突出病例进行了前瞻性研究。随访期为 6 个月。结果:在38名患者中,28.9%出现中度穿孔,65.8%出现大穿孔,5.3%出现小穿孔。92.1%的穿孔原因是粘膜慢性中耳炎,5.3%的穿孔原因是外伤,2.6%的穿孔原因是拔除通气管。平均手术时间为 27.2 ± 4.6 分钟。术后 6 个月的移植成功率为 94.7%(36/38)。术前平均气骨间隙(ABG)为 19.8 ± 4.2 dB,术后 ABG 为 8.6 ± 2.9 dB;这一改善具有显著的统计学意义(P < .001;配对样本 t 检验)。ABG 增益为 11.8 ± 5.1 dB,手术成功率(术后 ABG ≤ 20 dB)为 97.4%(37/38)。没有出现味觉改变、眩晕或耳鸣等并发症,也没有出现移植物侧移、明显变钝、移植物气胸、移植物粘连或渗出。不过,有 4 例(10.5%)患者出现了耳膜炎。结论内窥镜软骨片加固前缘技术是一种简单有效的方法,可用于修复伴有前管壁突出的前穿孔,移植物成功率高,听力改善,并发症少。
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Endoscopic Cartilage Slice Reinforcement Technique for Anterior Perforation Repair with Anterior Canal Wall Protrusion.

Objective: To evaluate the outcomes and complications of the endoscopic cartilage slice reinforcement technique used on anterior margins for anterior perforation repair with anterior canal wall protrusion. Material and Methods: We conducted a prospective study on 38 cases of anterior perforation with anterior canal wall protrusion, treated using the endoscopic cartilage slice reinforcement technique from February 1, 2017 to August 29, 2023. The follow-up period was 6 months. Results: Of the 38 patients, medium perforations were present in 28.9%, large in 65.8%, and subtotal in 5.3%. The cause was mucosal chronic otitis media in 92.1%, traumatic perforation in 5.3%, and ventilation tube removal in 2.6%. The average operation time was 27.2 ± 4.6 minutes. The graft success rate was 94.7% (36/38) at 6 months postoperative. The average preoperative air-bone gap (ABG) was 19.8 ± 4.2 dB, and postoperative ABG was 8.6 ± 2.9 dB; this improvement was statistically significant (P < .001; paired-sample t-test). The ABG gain was 11.8 ± 5.1 dB, and the rate of successful surgery (postoperative ABG ≤ 20 dB) was 97.4% (37/38). No complications such as altered taste, vertigo, or tinnitus were reported, and no cases involved graft lateralization, significant blunting, graft atelectasis, graft adhesions, or effusion. However, myringitis was observed in 4 (10.5%) patients. Conclusion: The endoscopic cartilage slice reinforcement technique for anterior margins is a simple and effective method for repairing anterior perforations with anterior canal wall protrusion, achieving a high graft success rate, improved hearing, and minimal complications.

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