【摘要】 目的探讨耳内镜下听骨链手术的可行性及疗效。方法回顾性分析2017年6月至2019年9月耳内镜手术探查确诊为先天性听骨链畸形15例(17耳),其中单纯镫骨底板固定3耳,伴有其他听骨链畸形的镫骨底板固定5耳,镫骨底板活动伴听骨链畸形8耳,前庭窗或蜗窗发育不良或闭锁1耳,依据其畸形类型分别行耳内镜下鼓室探查术+鼓室成型Ⅱ/Ⅲ型+人工听骨听力重建、鼓室探查术+镫骨底板钻孔/切除+人工镫骨活塞植入/置换术,观察并比较术前及术后3个月、术后1年的平均气导阈值(PTA)及平均气-骨导差(A-B Gap)。结果术前患者平均气导阈值(PTA)为53.47±12.34 dB HL,术后3个月平均气导阈值(PTA)为30.73±13.47 dB HL,术后1年平均气导阈值(PTA)为26.93±11.28 dB HL,相较于术前,术后3个月(t=6.926,P=0.000<0.001)、术后1年(t=7.266,P=0.000<0.001)气导阈值均明显改善,差异具有统计学意义,术后3个月与术后1年的气导阈值改善程度差异无统计学意义(t=1.059,P=0.305>0.05);术前患者平均气-骨导差(A-B Gap)为38.47±12.74 dB HL,术后3个月平均气-骨导差(A-B Gap)为16.73±10.74 dB HL,术后1年平均气-骨导差(A-B Gap)为12.43±9.07 dB HL,相较于术前,术后3个月(t=7.494,P=0.000<0.001)、术后1年(t=8.730,P=0.000<0.001)平均气-骨导差均明显缩小,差异具有统计学意义,术后3个月与术后1年的平均气-骨导差缩小程度差异无统计学意义(t=1.566,P=0.137>0.05)。术后无一例出现严重感音神经性耳聋、眩晕、面瘫等并发症。结论耳内镜下听骨链畸形手术短期内就能有效改善听力,且住院时间、手术时间短,微创治疗有效提高患者生活质量,从长远来看,听力改善效果也较为稳定,故听骨链畸形可通过耳内镜微创手术有效改善听力。更多还原

【Abstract】 Objective To report outcomes of endoscopic ear surgery for ossicular chain deformity. Methods This was a retrospective study including 15 patients(17 ears) with ossicular chain deformity treated by endoscopic surgery.Surgical findings included congenital stapes ankyloses(3 ears), stapes ankylosis associated with another congenital ossicular chain anomaly(5 ears), congenital ossicular chain anomaly with mobile stapes footplate(8 ears), and congenital aplasia or severe dysplasia of oval windows or round window(1 ear). All patients received endoscopic ear surgery designed for their particular ossicular chain deformities. Audiometric improvement after surgery was assessed. Results Pure tone average(PTA) was 53.47±12.34 dB HL before surgery, 30.73±13.47 dB HL at 3 months postop, and 26.93±11.28 dB HL at 1 year, respectively(t=6.926,P=0.000<0.001; t=7.266,P=0.000<0.001) with significantly reduced airbone gaps(t=7.494,P=0.000<0.001; t=8.730,P=0.000<0.001) and no complications such as severe sensorineural hearing loss, vertigo or facial paralysis. Conclusion Our study demonstrates that endoscopic ear surgery can be effectively applied for ossicular chain deformity with satisfactory short-term outcomes, as well as shorter hospitalization and surgery time. In addition, endoscopic ear surgery for ossicular chain deformity also provides better he long-term hearing improvement and therefore probably a preferable approach in the treatment of ossicular chain deformity.更多还原