完壁式乳突切除术与鼓室成形术联合治疗慢性化脓性中耳炎患者的随访研究

A follow-up study of wall mastoidectomy and tympanoplasty in the treatment of chronic suppurative otitis media

【目的】研究完壁式乳突切除术联合鼓室成形术治疗慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)患者的临床效果。【方法】选取2016年11月至2018年10月本院收治CSOM患者80例,根据治疗方案不同分为对照组(40例)和研究组(40例)。对照组采用开放式乳突切除术联合鼓室成形术治疗,研究组采用完壁式乳突切除术联合鼓室成形术治疗,术后随访3个月。比较2组手术情况(手术时间、术中出血量、术后住院时间)、治疗效果、术后不同时间段(1、12 h,1、2 d)疼痛程度、并发症发生率、鼓膜情况、术前及术后3个月听力指标(骨导听阈、气导听阈)变化情况。【结果】手术情况:研究组术后住院时间短于对照组,术中出血量低于对照组(P<0.05);治疗效果:研究组治疗总有效率(92.50%)高于对照组(75.00%)(P<0.05);疼痛程度:研究组术后1、12 h,1、2 d VAS评分均低于对照组(P<0.05);鼓膜情况:研究组术后鼓膜成活率(90.00%)高于对照组(72.50%)(P<0.05);听力指标:术后3个月,2组气导听阈及骨导听阈值均低于术前,且研究组低于对照组(P<0.05);并发症:2组并发症总发生率均较低,组间对比无显著差异(P>0.05)。【结论】完壁式乳突切除术联合鼓室成形术治疗CSOM患者疗效显著,术中创伤性低,术后疼痛感轻、并发症少、恢复快,能有效提高鼓膜成活率,改善患者术后听力情况,有助于改善患者预后。

【Objective】To study the clinical efficacy of mastoidectomy combined with tympanoplasty in the treatment of chronic suppurative otitis media(CSOM).【Methods】A total of 80 CSOM patients admitted to our hospital from November 2016 to October2018 were divided into the control group(n=40)and study group(n=40)according to different treatment schemes.The patients in the control group were treated with open mastoidectomy combined with tympanoplasty,and those in the study group were treated with wall mastoidectomy combined with tympanoplasty.The patients were followed up for 3 months.The operation conditions(operation time,intraoperative hemorrhage,postoperative hospital stay),treatment effect,pain degree(1、12 h,1、2 d),complication rate,tympanic membrane condition,hearing indexes(bone conduction threshold,air conduction threshold)before operation and 3 months after operation were compared between the two groups.【Results】The postoperative hospitalization time in the study group was shorter than that in the control group,and the intraoperative blood volume was less than that in the control group(P<0.05).As for the therapeutic effect,the total effective rate in the study group(92.50%)was higher than that in the control group(75.00%)(P<0.05).As for the pain degree,VAS score in the study group was lower than that in the control group(P<0.05).As for the tympanic membrane,the survival rate of tympanic membrane in the study group(90.00%)was higher than that in the control group(72.50%)(P<0.05).As for the hearing index 3 months after operation,the thresholds of air conduction and bone conduction in the two groups were lower than those before operation,and those in the study group were lower than those in the control group(P<0.05).As for the complications,there was no significant difference between the two groups(P>0.05).【Conclusion】The curative efficacy of mastoidectomy combined with tympanoplasty on CSOM is significant,the trauma is low during the operation,the postoperative pain is light,the complications are few,and the recovery is fast.Therefore,it can effectively improve the survival rate of tympanic membrane,the hearing situation and the prognosis of the patients.