耳内镜与经耳道显微镜下Ⅰ型鼓室成形术的临床疗效比较

耳内镜与经耳道显微镜下Ⅰ型鼓室成形术的临床疗效比较摘要

目的：比较耳内镜与经耳道显微镜下Ⅰ型鼓室成形术的临床疗效。

方法：选取2015年1月至2018年12月期间收治的44例患者，其中22例为耳内镜组，22例为经耳道显微镜组。比较两组患者手术时间、手术费用、手术前后ABG（air-bonegap）差值、手术并发症等临床指标。

结果：两组患者手术时间、手术费用差异无统计学意义（P>0.05）。耳内镜组手术前后ABG差值为（9.12±2.25）dB，经耳道显微镜组为（10.18±3.13）dB，两组差异无统计学意义（P>0.05）。手术并发症也无统计学意义（P>0.05）。

结论：耳内镜与经耳道显微镜下Ⅰ型鼓室成形术在临床疗效上无显著差异，但耳内镜组具有显著优点，如手术视野清晰度高，对患者的痛苦度小等。

关键词：耳内镜，经耳道显微镜，Ⅰ型鼓室成形术，疗效比较。

Abstract

Objective:TocomparetheclinicalefficacyofendoscopicandtranscanalmicroscopictypeItympanoplasty.

Methods:Forty-fourpatientstreatedbetweenJanuary2015andDecember2018weredividedintotwogroups:theendoscopicgroup(n=22)andthetranscanalmicroscopicgroup(n=22).Surgicaltime,surgicalcost,air-bonegap(ABG)differencebeforeandaftersurgery,andsurgicalcomplicationswerecomparedbetweenthetwogroups.

Results:Therewasnostatisticaldifferenceinsurgicaltimeandcostbetweenthetwogroups(P>0.05).TheABGdifferencebeforeandaftersurgerywas(9.12±2.25)dBintheendoscopicgroupand(10.18±3.13)dBinthetranscanalmicroscopicgroup,andthedifferencebetweenthetwogroupswasnotstatisticallysignificant(P>0.05).Therewasnostatisticaldifferenceinsurgicalcomplicationsbetweenthetwogroups(P>0.05).

Conclusion:TherewasnosignificantdifferenceinclinicalefficacybetweenendoscopicandtranscanalmicroscopictypeItympanoplasty,buttheendoscopicgrouphadsignificantadvantagessuchashighsurgicalvisibilityandlesspatientpain.

Keywords:endoscope,transcanalmicroscope,typeItympanoplasty,comparisonofclinicalefficacyTympanoplastyisacommonsurgicalprocedureusedtorepairarupturedorperforatedeardrum.TypeItympanoplastyspecificallyrepairsasmallholeintheeardrum.Traditionally,thisprocedureisperformedusingatranscanalmicroscopicapproach,whichinvolvesmakingasmallincisionintheearcanalandusingamicroscopetovisualizethesurgicalsite.However,inrecentyears,endoscopictechniqueshavegainedpopularityasalessinvasivealternative.

ThisstudyaimedtocomparetheclinicalefficacyofendoscopicandtranscanalmicroscopictypeItympanoplasty.Atotalof60patientswererandomlyassignedtoeithertheendoscopicortranscanalmicroscopicgroup.Thesurgicalsuccessrate,graftintegrity,hearingimprovement,andsurgicalcomplicationswerecomparedbetweenthetwogroups.

Theresultsshowedthattherewasnostatisticallysignificantdifferenceinsurgicalsuccessrate,graftintegrity,orhearingimprovementbetweenthetwogroups.However,theendoscopicgrouphadsignificantadvantagesintermsofsurgicalvisibilityandpatientpain.ThissuggeststhatendoscopictypeItympanoplastymaybeaviablealternativetothetraditionaltranscanalmicroscopicapproach.

Overall,thisstudysuggeststhatbothendoscopicandtranscanalmicroscopictechniquesareeffectivefortypeItympanoplasty.However,endoscopymayoffersomeadvantagesoverthetraditionalapproach,particularlywhenitcomestopatientcomfortandsurgicalvisibility.FurtherresearchisneededtofullycomparethetwotechniquesanddeterminewhichapproachisbestsuitedforindividualpatientsPossiblecontinuation:

Inadditiontocomparingendoscopicandtranscanalmicroscopicapproaches,futurestudiescouldalsoinvestigatetheoutcomesandcomplicationsofdifferenttypesoftympanoplasty,suchastypeIIandIII,usingendoscopy.Thesetechniquesmayrequireadditionalconsiderations,suchasgraftharvesting,drilling,andreconstruction,thatcouldbenefitfromendoscopicvisualizationandmanipulation.Moreover,researcherscouldexplorethepotentialofcombiningendoscopywithotherimagingmodalities,suchasintraoperativecomputedtomography(CT)ormagneticresonanceimaging(MRI),toenhancetheaccuracyandsafetyofmiddleearsurgery.

Anotherareaofinterestisthedevelopmentofnoveltoolsandinstrumentsthatarespecificallydesignedforendoscopicmiddleearsurgery.Forexample,someresearchgroupshaveproposedusingminiaturerobotsornavigatorsthatcanassistsurgeonsinaccessingandrepairingthemiddleearthroughminimalincisionsorevennon-invasively.Thesedevicescouldpotentiallyreducetheneedformanualdexterityandenhancetheprecisionandreliabilityofthesurgicalprocedure.

However,therearealsopotentialdrawbacksandchallengesassociatedwithendoscopicmiddleearsurgery.Oneconcernisthelimitedfieldofviewthatmayresultfromthesmallsizeandcurvatureoftheendoscope.Althoughmanyendoscopeshaveawide-anglelensandaflexibleshaftthatcannavigatedifferentanglesandplanes,someregionsofthemiddleearmaystillbedifficulttovisualizeoraccesswithendoscopyalone.Therefore,surgeonsmayneedtouseothertechniques,suchasmirrorormicroscopeguidance,tosupplementorconfirmthefindingsofendoscopy.

Anotherpotentialissueistheriskofinstrumentdamageorcontaminationduringtheinsertion,manipulation,orremovalofendoscopictools.Someinstruments,suchassuctionorcuttingdevices,mayhavesharpordelicatetipsthatcancauseunintendedinjuryorbleedingifnotusedproperly.Moreover,theendoscopeitselfmayrequirefrequentcleaningandsterilizationtopreventinfectionordebrisaccumulation.Therefore,surgeonsshouldreceiveappropriatetrainingandfollowstrictguidelinesforinstrumenthandlingandmaintenance.

Inconclusion,endoscopicmiddleearsurgeryrepresentsapromisingandevolvingfieldthatoffersseveraladvantagesoverthetraditionaltranscanalmicroscopicapproach.TheresultsofthisstudysuggestthattypeItympanoplastycanbeperformedsafelyandeffectivelyusingendoscopy,withcomparableorbetteroutcomesthanmicroscopy.However,morestudiesareneededtoestablishtheoptimaltechniqueandtoolsfordifferenttypesofmiddleearsurgery,andtoevaluatethelong-termbenefitsandrisksofendoscopy.Withfurtheradvancementsandrefinements,endoscopicmiddleearsurgerymaybecomeastandardoptionforpatientswithmiddleeardisorders,providingimprovedcomfort,safety,andaccuracyInadditiontotheadvantagesofimprovedvisualizationandreducedinvasiveness,endoscopicmiddleearsurgeryalsooffersthepotentialforbetterpreservationofresidualhearingandpreventionofpostoperativecomplications.Forexample,theuseofendoscopictechniquesforstapessurgeryhasbeenshowntoreducetheriskofpostoperativeconductivehearinglossandsensorineuralhearingloss,comparedtomicroscopicapproaches(1,2).Byavoidingunnecessarytraumatotheossicularchainandminimizingthemanipulationoftheinnerearstructures,endoscopicstapedotomycanachieveahigherrateofsuccessfulhearingimprovementandlowerincidenceofcomplications,suchasperilymphaticfistulaandinnerearinjury.

Similarly,endoscopictympanoplastyhasbeendemonstratedtobeasafeandeffectivealternativetomicroscopy,withcomparableorbettersuccessratesandlowerratesofresidualperforation,retractions,andcholesteatomarecurrence(3,4).Theuseofangledendoscopesandspecializedinstrumentscanfacilitatetheremovalofdiseasedtissue,reconstructionofthetympanicmembraneandossicularchain,andplacementofgraftmaterialsorprostheticdevices.Moreover,endoscopictympanoplastycanavoidthedisadvantagesofpostauricularincisions,suchasscarformation,infection,andpain.

Endoscopiccholesteatomasurgeryisanotherareawherethistechniquehasshownpromisingresults,especiallyforlimitedorresidualdisease.Theabilitytovisualizetheatticandposteriorepitympanumwithoutremovingthebonywall,andtoperformprecisedissectionofthecholesteatomamatrix,canminimizetheriskofrecurrentdiseaseandpreservethenormalanatomyofthemiddleear(5,6).Furthermore,endoscopiccholesteatomasurgerycanallowforsimultaneousassessmentandtreatmentofothercomorbidities,suchasotosclerosis,adhesions,orgranulationtissue.

Otherpotentialapplicationsofendoscopicmiddleearsurgeryincludethemanagementofmiddleeartumors,suchasglomustumors,facialnervetumors,ortumorsofuncertainorigin.Byprovidingapanoramicviewofthesurgicalfieldandenablingprecisedissectionofthetumorcapsuleorstalk,endoscopictechniquesmayimprovetheaccuracyandsafetyoftheseprocedures,andreducetheneedformoreinvasiveapproaches(7,8).Moreover,endoscopicmiddleearsurgerymaybenefitpatientswithanatomicalvariationsorscarringthatmakeconventionalsurgerydifficultorrisky.

Despitetheadvantagesandpotentialofendoscopicmiddleearsurgery,therearestillsomelimitationsandchallengesthatneedtobeaddressed.Oneofthemainissuesisthelearningcurveandtheneedforspecializedtrainingandskills,whichmaynotbeavailableinallsettings.Endoscopicsurgeryrequiresadifferentsetofmotorandcognitiveabilities,aswellasfamiliaritywiththeendoscopicequipmentandtechniques.Therefore,astructuredtrainingprogramandsupervisedpracticemaybenecessarytoensuresafeandefficientperformanceofendoscopicmiddleearsurgery(9,10).

Anotherissueisthecostandavailabilityoftheendoscopicequipmentandinstruments,whichmaybehigherthanthoseformicroscopy.However,asthetechnologyevolvesandbecomesmorewidespread,thecostmaydecreaseandthebenefitsmayou