耳内镜下听骨链重建探讨及初步疗效观察

目的探讨耳内镜下进行听骨链重建术的可行性。方法对1998年5月至2011年2月应用耳内镜(直径2.7mm,视角为0°或30°)行听骨链重建的52例病人进行回顾性分析,并对其近期疗效初步评估。结果 52例患者全部顺利在耳内镜下完成手术,其中耳硬化症25例,鼓室硬化症19例,听骨链部分缺损8例。耳硬化症患者4例采用镫骨底板部分切除,21例采用小窗技术,7例无需外道后上壁盾板切除,即可在内镜下完成手术。鼓室硬化症8例去除病灶行镫骨撼动,11例切除砧骨及镫骨上结构,采用TORP或Piston进行听骨链重建。听骨链部分缺损采用TORP或PORP人工听骨连接,重建听骨链。经随访6个月以上的病例有40例,其中35例术后听力有明显改善,骨气导差在15dB以内,近期疗效满意。结论根据初步临床应用观察,认为耳内镜可以用于听骨链重建手术,尤其是耳硬化症患者。其优点是创伤小,恢复快,缺点是耳内镜下进行单手精细操作有一定难度,对于外耳道狭窄者不适宜。

Transcanal endoscopic reconstruction of ossicular chain

Objective To evaluate the feasibility of transcanal endoscopic reconstruction of ossicular chain. Methods Clinical data and short-term therapeutic effects in 52 patients who underwent transcanal endoscopic (2.7 mm diameter, 0° or 30° visual angle) reconstruction of ossicular chain from May 1998 to February 2011 were reviewed retrospectively. Results The procedure was successful in all the patients, including 25 cases of otosclerosis, 19 cases of tympanosclerosis and 8 cases of partial ossicular defects. Of the cases of otosclerosis, 4 received partial resection of the stapedial footplate and 21 underwent stapedotomy. In 7 of the latter, endoscopic operation was completed without resection of the scutum in posteriosuperior canal wall. For tympanosclerosis, 8 patients underwent lesion resection plus stapediolysis, 11 patients received incus and up stapes resection plus TORP or Piston. In partial ossicular defects, patients underwent reconstruction with TORP or PORP. Of the patients, 40 were followed up for more than six months, during which period hearing showed significant improved in 35 of the 40 patients with air-bone gap within 15 dB and general patient satisfaction. Conclusion Based on this preliminary observation, we conclude that transcanal endoscopic reconstruction of ossicular chain is a feasible procedural option for patients with otosclerosis. Its advantages include minimal invasion and reduced recovery time. It however makes elaborate maneuvers challenging as it is a single hand operation, and is thus not suitable in cases with external auditory canal stenosis.