內視鏡鼓室成形術

Endoscopic Tympanoplasty

曾智傑(Chih-Chieh Tseng)

《台灣耳鼻喉頭頸外科雜誌》 51卷2期 (2016/06) Pp. 82-87

https://doi.org/10.6286/2016.51.2.82

摘要

背景：自從1940年代後，在顯微鏡下施行鼓室成形術己成為治療中耳炎併耳膜破洞的主要方式。然而，在1990年代後開始有學者報導利用內視鏡施行鼓室成形術。因此本研究探討在局部麻醉下、以門診手術方式、無論耳膜破洞範圍、利用內視鏡鼓室成形術治療中耳炎耳併耳膜破洞的可行性。方法：前瞻性連續收集150例中耳炎併耳膜破洞的病例，施行內視鏡鼓室成形術。手術以局部麻醉、門診手術方式進行。收集病例資料，包括年齡、性別、耳膜破洞範圍、手術前後聽力檢查、術後頭暈比率、耳膜移植成功率等因子進行統計分析。結果：共有152名病例接受內視鏡鼓室成形術手術，其中136名病例追蹤至少3個月，並有完整手術前後的聽力檢查。病例年齡平均52.7 ± 12.9歲(20-86歲)；男性65名，女性71名；右耳66例，左耳70例；手術耳膜移植成功率平均為94.8%；手術前52%的病例氣骨導差小於20 dB、手術後87%的病患氣骨導差小於20 dB；手術前後氣導平均進步12.8 ± 11.1 dB ( p ＜ 0.05)。以羅吉斯迴歸分析發現耳膜移植成功率和病例是否為再次手術達到統計顯著的相關性( p ＜ 0.05)。結論：本研究結果顯示中耳炎併耳膜破洞、無論破洞範圍大小、均可用門診內視鏡鼓室成形術治療。此種治療模式耳膜移植成功率高、手術時間短、限制條件少、是一項值得推廣的手術方式。

關鍵字

中耳炎 ； 耳膜破洞 ； 內視鏡 ； 鼓室成形術 ； 門診

並列摘要

BACKGROUND: Since 1940s, tympanoplasty under the microscope has become the standard treatment of chronic otitis media (COM) with tympanic perforations. However, since 1990s, tympanoplasty under the endoscope has been reported increasingly. Therefore, the aim of this study was to evaluate the possibility of outpatient endoscopic tympanoplasty for all kinds of COM with tympanic perforations. METHODS: Prospectively, 150 consecutive patients of COM with tympanic perforations were enrolled. All patients underwent outpatient endoscopic tympanoplasty under local anesthesia. The patient data, including age, sex, the size of tympanic perforations, preoperative and postoperative hearing tests, the rate of postoperative vertigo, the take-up rate of the graft, were collected for statistical analysis. RESULTS: A total of 152 patients were treated, of which 136 patients had a follow-up period of at least three months with complete hearing tests. The average age was 52.7 ± 12.9 years old (range, 20-86 years old). There were 65 male and 71 female with 66 right ears and 70 left ears. The average graft take-up rate was 94.8%. Preoperatively, 52% patient had an air-bone gap smaller than 20 dB, whereas postoperatively 87% patient had the same level. The average gain of air conduction was 12.8 ± 11.1 dB ( p ＜ 0.05). The result of logistic regression showed the success rate had statistical association with revision surgery ( p ＜ 0.05). CONCLUSIONS: According to this study, COM with tympanic perforations, regardless of the perforation size, can be treated with endoscopic tympanoplasty on an outpatient basis. This treatment model has a high success rate and less surgical limitations, which is worth to be promoted.

並列關鍵字

otitis media ； tympanic perforations ； endoscope ； tympanoplasty ； outpatient