持续灌流模式耳内镜下粘连性中耳炎手术疗效分析

Analysis of the surgical efficacy of adhesive otitis media under continuous irrigating mode for endoscopic ear surgery

摘要

目的 探讨持续灌流模式耳内镜手术(continuous irrigating mode for endoscopic ear surgery, CIM-EES)在粘连性中耳炎中的临床应用价值及其疗效。方法 通过收集厦门大学附属东南医院耳鼻咽喉科2023年2月1日至2024年6月1日确诊的36例粘连性中耳炎患者的临床资料,所有患者均在全麻下行鼓室成形术(含人工听骨听力重建)。其中19例患者采用CIM-EES完成手术,17例患者则在常规模式耳内镜下完成手术,对比两组患者的手术时间、术中中耳结构可见度指数(middle ear structural visibility index, MESVI)、术后并发症、听力改善情况等。结果 CIM-EES组MESVI评分(8.11±1.59)高于常规模式组(4.47±1.23)(t=7.59,P<0.001);CIM-EES组平均手术时间(1.52±0.42)h短于常规模式组(1.97±0.38)h (t=-3.31,P=0.002);CIM-EES组术前气导听力(48.92±18.23) dB、术后气导听力(41.76±17.98) dB与常规模式组手术前后气导听力(47.75±18.62)dB、(37.97±15.29)dB比较,两组术后听力均较术前改善(t=5.26,P<0.01;t=4.12,P<0.01);CIM-EES组与常规模式组均未出现术后并发症,但CIM-EES组的鼓索神经保存率高于常规模式组。结论 CIM-EES治疗粘连性中耳炎能更有效地缩短手术时间,提供更清晰的手术视野、可减少术后并发症发生,是一种安全高效的手术方式,值得临床上推广应用。

Abstract

Objective To evaluate the clinical application value and surgical efficacy of Continuous Irrigating Mode for Endoscopic Ear Surgery (CIM-EES) in the treatment of adhesive otitis media. Methods Clinical data were retrospectively collected from 36 patients diagnosed with adhesive otitis media who underwent tympanoplasty (including artificial ossicular reconstruction) under general anesthesia in the Department of Otorhinolaryngology, Dongnan Hospital of Xiamen University from February 1, 2023 to June 1, 2024. Among these patients, 19 were treated using CIM-EES, while the remaining 17 underwent surgery under conventional otoendoscopic techniques. The operative duration, intraoperative middle ear structural visibility index (MESVI), postoperative complications, and hearing improvement were compared between the two groups. Results The MESVI score in the CIM-EES group (8.11±1.59) was significantly higher than that in the conventional group (4.47±1.23) (t=7.59, P<0.001). The average operation time in the CIM-EES group (1.52±0.42) hours was significantly shorter than that in the conventional group (1.97±0.38) hours (t=-3.31, P=0.002). No significant difference was observed in preoperative and postoperative air conduction thresholds between the CIM-EES group (preoperative: 48.92±18.23 dB; postoperative: 41.76±17.98 dB) and the conventional group (preoperative: 47.75±18.62 dB; postoperative: 37.97±15.29 dB) (t=5.26, P<0.01; t=4.12, P<0.01). No major postoperative complications were observed in either group; however, the preservation rate of the tympanic nerve was higher in the CIM-EES group compared to the conventional group. Conclusion CIM-EES could shorten operative time, demonstrating statistical advantages in improved intraoperative visualization and better preservation of anatomical structures in the surgical management of adhesive otitis media. It is a safe, efficient, and promising technique suitable for broader clinical application.

关键词

耳内镜手术 / 粘连性中耳炎 / 持续灌流模式

Key words

Endoscopic ear surgery / Adhesive otitis media / Continuous irrigating mode

参考文献

[1] Mansour S , Magnan J , Haidar H , et al. Tympanic Membrane Retraction Pocket: Overview and Advances in Diagnosis and Management[M]. Cham:Springer International Publishing, 2015.

[2] Dommerby H , Tos M . Sensorineural hearing loss in chronic adhesive otitis[J]. Arch Otolaryngol Head Neck Surg, 1986, 112(6): 628-634. doi: 10.1001/archotol.1986.03780060040005.

[3] Ichimura K , Ishikawa K , Nakamura KI , et al. Cartilage palisade tympanoplasty for adhesive otitis media[J]. Nihon Jibiinkoka Gakkai Kaiho, 2009, 112(6): 474-479. doi: 10.3950/jibiinkoka.112.474.

[4] Tos M , Stangerup SE , Larsen P . Dynamics of ear drum changes following secretory otitis. A prospective study[J]. Arch Otolaryngol Head Neck Surg, 1987, 113(4): 380-385. doi: 10.1001/archotol.1987.01860040042014.

[5] Sadé J . The buffering effect of middle ear negative pressure by retraction of the pars tensa[J]. Am J Otol, 2000, 21(1): 20-23.

[6] Sadé J . Secretory Otitis Media and Its Sequelae[M]. Ne York: Churchill Livingstone, 1979.

[7] Ruah CB , Schachern PA , Paparella MM , et al. Mechanisms of retraction pocket formation in the pediatric tympanic membrane[J]. Arch Otolaryngol Head Neck Surg, 1992, 118(12): 1298-1305. doi: 10.1001/archotol.1992.01880120024005.

[8] Mansour S , Magnan J , Nicolas K , et al. Adhesive otitis media[M]// Middle Ear Diseases. Cham: Springer International Publishing, 2018: 143-160. doi: 10.1007/978-3-319-72962-6_4

[9] Glikson E , Yousovich R , Mansour J , et al. Transcanal endoscopic ear surgery for middle ear cholesteatoma[J]. Otol Neurotol, 2017, 38(5): e41-e45. doi: 10.1097/MAO.0000000000001395

[10] 廖华, 虞幼军, 侯昭晖 . 持续灌流模式下的耳内镜外科手术[J]. 中华耳科学杂志, 2021, 19(2): 192-197. doi: 10.3969/j.issn.1672-2922.2021.02.002.

[11] LIAO Hua , YU Youjun , HOU Zhaohui . Continuous irrigation in endoscopic ear surgery[J]. Chinese Journal of Otology, 2021, 19(2): 192-197. doi: 10.3969/j.issn.1672-2922.2021.02.002

[12] Cassano M , Cassano P . Retraction pockets of pars tensa in pediatric patients: clinical evolution and treatment[J]. Int J Pediatr Otorhinolaryngol, 2010, 74(2): 178-182. doi: 10.1016/j.ijporl.2009.11.004

[13] Borgstein J , Stoop E , Halim A , et al. The extraordinary healing properties of the pediatric tympanic membrane: a study of atelectasis in the pediatric ear[J]. Int J Pediatr Otorhinolaryngol, 2008, 72(12): 1789-1793. doi: 10.1016/j.ijporl.2008.08.010

[14] Li WQ , Du Q , Wang WQ . Treatment of adhesive otitis media by tympanoplasty combined with Fascia grafting catheterization[J]. Eur Arch Otorhinolaryngol, 2019, 276(10): 2721-2727. doi: 10.1007/s00405-019-05514-5

[15] Si Y , Chen YB , Xu G , et al. Cartilage tympanoplasty combined with eustachian tube balloon dilation in the treatment of adhesive otitis media[J]. Laryngoscope, 2019, 129(6): 1462-1467. doi: 10.1002/lary.27603

[16] Li W , Du Q , Wang W . Treatment of adhesive otitis media by tympanoplasty combined with Fascia grafting catheterization[J]. Eur Arch Otorhinolaryngol, 2019, 276(10): 2721-2727. doi: 10.1007/s00405-019-05514-5

[17] Özdoğan F , Özel HE , Köroğlu E , et al. Endoscopic and microscopic tympanoplasty for adhesive otitis media: a comparative prospective analysis[J]. Med Sci Monit, 2024, 30: e945152. doi: 10.12659/MSM.945152

基金资助

漳州市科技计划项目(ZZ2025LH57)