慢性中耳疾病的内镜手术：手术技术与结果的叙述性综述。

文献信息

中文摘要

内镜耳外科（EES）通过实现微创经耳道入路并增强中耳解剖结构的可视化，正在改变当代耳科实践。本叙述性综述总结了当前关于EES在鼓室成形术、听骨链重建术和胆脂瘤手术中的技术考量、临床应用及近期证据。影响安全性和有效性的技术因素包括成角内镜的使用、光源热风险的管理、止血、水下内镜技术以及新兴的数字图像增强系统。对于I型鼓室成形术，内镜与显微镜入路可获得相当的移植物成活率和听力结果，而EES可能减少手术时间、术后疼痛、伤口相关并发症及入路相关并发症，尤其是与耳后显微镜手术相比。内镜听骨链重建术也显示出与显微镜重建术相当的听力学结果，在成人和儿童人群中均可能在手术效率和术后恢复方面具有潜在优势。在胆脂瘤手术中，EES提供广角可视化和进入隐藏隐窝的通道，荟萃分析提示与传统显微镜入路相比，残留或复发疾病率更低。然而，疾病范围，尤其是乳突受累，仍是手术策略的关键决定因素。总体而言，EES是一种安全、有效且多用途的慢性中耳疾病治疗技术，可提供优异的临床和听力学结果，且手术并发症极少。

英文摘要

Endoscopic ear surgery (EES) is transforming contemporary otologic practice by enabling minimally invasive transcanal access and enhanced visualization of middle ear anatomy. This narrative review summarizes current technical considerations, clinical applications, and recent evidence regarding EES in tympanoplasty, ossiculoplasty, and cholesteatoma surgery. Technical factors influencing safety and efficacy include the use of angled endoscopes, the management of thermal risk from light sources, hemostasis, underwater endoscopic techniques, and emerging digital image enhancement systems. For type I tympanoplasty, endoscopic and microscopic approaches achieve comparable graft uptake and hearing outcomes, while EES may reduce operative time, postoperative pain, wound-related complications, and approach-related morbidity, particularly compared with postauricular microscopic surgery. Endoscopic ossiculoplasty also demonstrates audiological outcomes comparable to microscopic reconstruction, with potential benefits in operative efficiency and postoperative recovery in both adult and pediatric populations. In cholesteatoma surgery, EES provides wide-angle visualization and access to hidden recesses, and meta-analyses suggest lower residual or recurrent disease rates compared with traditional microscopic approaches. However, disease extension, particularly mastoid involvement, remains a key determinant of surgical strategy. Overall, EES is a safe, effective, and versatile technique for chronic middle ear disease, offering excellent clinical and audiological outcomes with minimal surgical morbidity.