內視鏡內嵌式軟骨鼓室成形術：單一醫院經驗

Endoscopic Butterfly Inlay Tympanoplasty in a Single Hospital

劉得懿(Te-Yi Liu) ； 王拔群(Pa-Chun Wang)

《台灣耳鼻喉頭頸外科雜誌》 56卷4期 (2021/12) Pp. 223-229

https://doi.org/10.6286/jtohns.202112_56(4).223

摘要

背景：傳統鼓室成形術是在顯微鏡下，以顳肌筋膜或軟骨膜修補破損耳膜。自90年代後開始，有學者利用内視鏡實施鼓室成形術；1998年另有學者提出可在局部麻醉下進行的內嵌式軟骨鼓室成形術。本研究探討內視鏡下實施内嵌式軟骨鼓室成形術之成效。方法：以回溯性分析，收集新竹某地區醫院於2019年7月至2020年12月間，接受內視鏡內嵌式軟骨鼓室成形術的所有病患。收集資料，包括年齡、性别、耳膜破洞大小、手術時間、麻醉方式、手術前後聽力閾值、手術成功率等因子進行統計分析。結果：24名患者（25耳），共23名患者回診（24耳）。平均年齡為69.5歲（19歲至90歲），女性10例男性14例。穿孔大於一個象限有9例（破洞面積30％至50％），穿孔小於一個象限有16例（破洞面積5％至25％）。手術時間為45.7分鐘（33至79分鐘）。術後聽力追蹤時間平均為4.8個月（1至15個月），術後耳膜修補成功23例（95％），失敗1例（5％）。手術成功之23耳，其術前聽力平均閾值為50.0 ± 17.1 dB，術後聽力平均閾值為39.5 ± 17.6 dB（進步10.5±7.8 dB），術前平均氣骨導差為20.1 ± 8.4 dB，術後平均氣骨導差為10.2 ± 8.3 dB（進步9.9 ± 8.4 dB）。結論：内視鏡内嵌式軟骨鼓室成形術比起傳統顯微鏡耳後內置法鼓室成形術，手術時間短、限制條件少，大部份的情況可於局部麻醉門診手術完成，為鼓膜修補手術之另一種選擇。

關鍵字

endoscope ； inlay tympanoplasty ； otitis media ； tympanic perforation（内視鏡 ； 內嵌式鼓室成形術 ； 中耳炎 ； 耳膜破洞）

並列摘要

BACKGROUND: Tympanoplasty is a surgical procedure for repairing eardrum defects with the temporalis fascia or perichondrium using a microscope. In 1990, tympanoplasty under endoscopy was introduced, followed by inlay butterfly cartilage tympanoplasty in 1998. This study focused on the results and effectiveness of endoscopic butterfly inlay tympanoplasty in a single hospital. METHODS: This retrospective study was performed at a Hsinchu district hospital. The patient underwent endoscopic butterfly inlay tympanoplasty from July 2019 to December 2020. Data were collected as follows: age, sex, size of perforation, operation time, the threshold of pure tone audiometry, and air-bone gap. RESULTS: There were 23 patients (24 ears) with an average age of 69.5 (19-90 years) who underwent endoscopy inlay tympanoplasty under local anesthesia in most cases (21/24). The graft take rate was 95% (of 23/24). The mean pre- and post-operative hearing thresholds were 50.0 ± 17.1 dB and 39.5 ± 17.6 dB, respectively. The average air-bone gap closure was 9.9 ± 8.4 dB. CONCLUSIONS: In compare with conventional retroauricular microscopic tympanoplasty, endoscopic butterfly inlay tympanoplasty has shorter operation time, less surgical limitations. Most of the time, it can be office-based procedure under local anesthesia as an alternative to tympanoplasty.

並列關鍵字

endoscope ； inlay tympanoplasty ； otitis media ； tympanic perforation