耳内镜在听骨链探查及重建中的应用

目的 研究耳内镜在听骨链探查及重建中的应用效果。方法 回顾性分析2019年2月-2021年5月该院64例（64耳）听骨链探查鼓室成形术患者的临床资料。耳内镜组采用耳内镜手术，显微镜组采用显微镜手术。结果 在病变范围未超过鼓窦的患者中，耳内镜组术中出血量少于显微镜组，手术时间和住院时间短于显微镜组，疼痛评分和不良反应率低于显微镜组，差异均有统计学意义（P <0.05）；术后6个月，耳内镜组鼓膜愈合率为93.3%(28/30)，显微镜组鼓膜愈合率为91.2%(31/34)，两组患者均能获得较高的鼓膜愈合率以及纯音听阈均值（PTA）的改善，但组间比较，差异无统计学意义（P> 0.05）。术后在听骨链重建的患者中，耳内镜组人工听骨植入患者气骨导间距（A-B gap）缩小程度大于显微镜组，差异有统计学意义（P <0.05）。结论 在病变未超过鼓窦的患者中，选择耳内镜手术优势较多，具有临床实用价值。

Application of otoscope in ossicular chain exploration and reconstruction

Objective To study the effect of otoscope in the exploration and reconstruction of ossicular chain.Methods Clinical data of 64 patients (64 ears) with ossicular chain exploration tympanoplasty from February 2019 to May 2021 were retrospectively analyzed, and their surgical characteristics and therapeutic effects were analyzed. The patients in the otoscope group were treated by otoscope, and the patients in the microscope group were treated by microscope.Results In the patients whose lesion scope did not exceed the tympanic sinus, the intraoperative bleeding in the otoscope group was significantly less than that in the microscope group, the operation time and hospital stay in the otoscope group were significantly shorter than those in the microscope group, the pain score and adverse reaction rate in the otoscope group were significantly lower than those in the microscope group (P < 0.05). After 6 months, the healing rate of tympanic membrane in otoscope group was 93.3% (28/30); The tympanic membrane healing rate in the microscope group was 91.2% (31/34). Both groups could obtain better tympanic membrane healing and the improvement of pure tone average (PTA). There was no significant difference between the two groups (P > 0.05). Among the patients with ossicular chain reconstruction after operation, the reduction of air-bone gap (A-B gap) in patients with artificial ossicular implantation in the otoendoscope group was greater than that in the microscope group (P < 0.05).Conclusion In patients whose lesions do not exceed the tympanic sinus, the choice of otoscopic surgery has more advantages and clinical practical value.