不同手术方式治疗上鼓室胆脂瘤型中耳炎临床观察

Clinical observation on treatment of otitis media with superior tympanic cholesteatoma by different surgical methods

目的探讨不同手术方式治疗上鼓室胆脂瘤型中耳炎患者的效果及对干耳时间、术腔大小及术后听力水平的影响。方法选取2018-03-16-2020-09-10濮阳市油田总医院耳鼻喉科收治的117例上鼓室胆脂瘤型中耳炎患者为研究对象,根据随机数字表法分为对照组(n=58)和观察组(n=59)。对照组给予完壁式乳突切开+鼓室成形术,观察组给予上鼓室路径保留乳突的改良完壁式鼓室成形术,对比2组患者手术效果、术腔情况、听力水平、并发症发生情况及复发率。结果干预后,观察组手术时间为(4.36±1.26)h,少于对照组的(6.35±2.37)h,t=8.394,P<0.001;出血量为(153.67±48.09)mL,少于对照组的(210.67±34.38)mL,t=29.951,P<0.001;住院时间为(19.59±5.06)d,少于对照组的(24.67±6.12)d,t=12.559,P<0.001。干预后,观察组并发症发生率为8.47%,低于对照组的25.86%,χ^(2)=5.827,P=0.016。干预后,观察组气导听阈为(27.75±4.37)dBHI,低于对照组的(38.60±2.10)dBHI,t=17.070,P<0.001;气骨导差为(13.77±1.63)dBHI,低于对照组的(18.96±2.39)dBHI,t=12.897,P<0.001。干预后,观察组干耳时间为(4.34±1.29)周,低于对照组的(10.69±0.35)周,t=36.470,P<0.001;术腔容量为(4.18±1.37)V/mL,低于对照组的(1.56±1.19)V/mL,t=11.049,P<0.001;术腔上皮化为(2.67±1.29)个月,低于对照组的(4.64±1.34)个月,t=8.102,P<0.001。干预后,观察组鼓室压力为(-18.15±1.56)daPa,低于对照组的(-35.17±1.85)daPa,t=56.832,P<0.001。干预后,观察组复发率为1.69%,低于对照组的8.62%,χ^(2)=5.802,P<0.001。结论上鼓室胆脂瘤型中耳炎患者采用上鼓室路径保留乳突的改良完壁式鼓室成形术效果好、安全性高、并发症少,能够提高听力水平、减少复发率。

Objective To investigate the effect of different surgical methods in the treatment of upper tympanic cholesteatoma otitis media and the effect on dry ear time,intraoperative cavity size and postoperative hearing level.Methods A total of 117 patients with choladiatoma otitis media in the upper tympanic treated in the Department of Otolaryngology,Puyang Oilfield General Hospital from March 16,2018 to September 10,2020 were selected as the study subjects.They were divided into control group(n=58)and observation group(n=59)according to random number table method.The control group was given complete wall mastoidectomy+tympanoplasty,and the observation group was given modified complete wall tympanoplasty with mastoid preservation through the superior tympanum pathway.The surgical effect,operative lumen,hearing level,incidence of complications and recurrence rate of 2 groups were compared.Results After intervention,the operation time of the observation group was(4.36±1.26)h,less than that of the control group(6.35±2.37)h,t=8.394,P<0.001.The amount of blood loss was(153.67±48.09)ml,less than(210.67±34.38)ml in the control group,t=29.951,P<0.001.The length of hospital stay was(19.59±5.06)d,less than that of the control group(24.67±6.12)d,t=12.559,P<0.001.After intervention,the incidence of complications in the observation group was 8.47%,lower than 25.86%in the control group(χ^(2)=5.827,P=0.016).After intervention,the audiothreshold of air conductance in the observation group was(27.75±4.37)dBHI,which was lower than that in the control group(38.60±2.10)dBHI,t=17.070,P<0.001.The difference of bone conductance was(13.77±1.63)dBHI,which was lower than that of the control group(18.96±2.39)dBHI,t=12.897,P<0.001.After intervention,dry ear time in the observation group was(4.34±1.29)weeks,lower than that in the control group(10.69±0.35)weeks,t=36.470,P<0.001.The intraoperative lumen volume was(4.18±1.37)V/ml,lower than that of the control group(1.56±1.19)V/ml,t=11.049,P<0.001.Intraoperative cavity epithelialization(2.67±1.29)months was lower than that of the control group(4.64±1.34)months,t=8.102,P<0.001.After intervention,the tympanum pressure of the observation group was(-18.15±1.56)daPa,lower than that of the control group(-35.17±1.85)daPa,t=56.832,P<0.001.After intervention,the recurrence rate of the observation group was 1.69%,lower than that of the control group 8.62%,χ^(2)=5.802,P<0.001.Conclusion Patients with upper tympanic cholesteatoma otitis media who was given modified complete wall tympanoplasty with mastoid preservation through the superior tympanum pathway has good effect,high safety,less complications,and can improve the hearing level and reduce the recurrence rate.