镫骨手术治疗鼓室硬化症远期疗效观察

Long-term effect of stapes surgery on tympanosclerosis

目的探讨镫骨手术治疗鼓室硬化症远期疗效及其影响因素.方法回顾性总结解放军总医院耳鼻咽喉科1984年4月至2002年3月接受镫骨手术的鼓室硬化症患者共125例(157耳),对随访半年以上、资料完整的119例(149耳)进行回顾性总结,应用Stata7.0统计软件进行统计学分析.语言频率气导听力(听力级,下同)增进15 dB以上或者达到应用听力水平为手术成功标准.结果本组患者术前气导听力平均(50.7±12.1) dB,听力损失主要以低频为主.术后半年气导平均听力为(25.6±15.2)dB.半年、1年、2年、5年以上手术成功率分别为50.3%、45.8%、41.3%、34.5%.手术方式的选择:镫骨钻孔活塞术(Teflon小柱)术后气导听力增进较好,半年后成功率为62.5%,镫骨切除术(自体骨或者异体骨重建听骨链)、镫骨撼动术半年后成功率分别为43.1%和30.8%, 3种手术方式经卡方检验,前10年各阶段气导增进均以镫骨钻孔活塞术高于镫骨切除术,镫骨撼动术最低,差异有统计学意义(P<0.05).术后随访0.5～18年语言频率气导平均听阈,数据以听力阈值30 dB为标准,经Ridit分析,5年内无明显下降(P>0.05);5年后下降显著(P<0.05),说明平均气导听力随术后时间延长有下降趋势.手术效果影响因素是多方面的,按程度排列分别为术后时间、镫骨周围病变、手术方式、和术中并发症.结论镫骨手术是治疗鼓室硬化症致镫骨病变的一种有效的外科方法,但远期疗效比较差.选择合适的镫骨手术方式对维持术后远期效果稳定比较重要.

Objective To study the long-term effect of stapes surgery on tympanosclerosis and its influence factors. Methods The effect of stapes surgery on tympanosclerosis was retrospectively summed up in 119 patients (149 ears) in General Hospital of people′s Liberation Army from April 1984 to March 2002. The Stata 7.0 software was used as a statistical tool. Results The average of hearing threshold (hearing level) of air conduction was (50.7 ± 12.1) dB before operation, and the hearing loss was mostly on low frequency. Following-up the half-year post-operation, the average of hearing threshold of air conduction was (25.6 ± 15.2) dB. The total successful rate of post-operation half year, 1 year, 2 and 5 years were 50.3%, 45.8%, 41.3% and 34.5%, respectively. Comparing the different operation methods, stapedotomy (piston technique) owned the best effect on hearing recovery (62.5%), then was stapedectomy (43.1%), but the last one was stapediolysis (30.8%). There was significant difference effect among three different operation methods (P<0.05) . The average of hearing threshold of air conduction was steadily within the first five-years following-up(Ridit analysis, P>0.05),but obviously increased more than 5 years after operation(Ridit analysis, P<0.05). The influence factors to successful rate were the following-up time post-operation, pathological changes of stapes, operative methods, and complications during operation, respectively. Conclusion Stapes surgery is the effective method to treat tympanosclerosis, but the long-term effect is not good enough as expectation. It is important to select proper operation methods for better hearing results.