完整鼓室的乳突开放式鼓室成形术与开放式鼓室成形术的比较

The comparison between different surgical approaches for chronic otitis media and middle ear cholesteatoma

目的探讨慢性中耳炎和胆脂瘤中耳炎手术方式及适应症的选择,比较完整鼓室的乳突开放式鼓室成形术与开放式鼓室成形术二种术式治疗慢性中耳炎的疗效。方法回顾性分析2005年1月—2007年5月期间97例(99耳),其中胆脂瘤中耳炎71耳,慢性中耳炎28耳,根据病灶范围选用完整鼓室的乳突开放式鼓室成形术(A组)22例(22耳)与开放式鼓室成形术(B组)75例(77耳)。对二组病例术前和术后纯音测听平均值PAT(500、1kHz、2kHz、4kHz)、气骨导差(ABG)等进行统计与比较。结果术后随访6个月￣34个月,总干耳率93.9%(93/99),胆脂瘤复发率为7.0%(5/71);术后气导(AC)提高值≥10dB为60.6%,气骨导差(ABG)≤20dB为29.3%;其中A组术后AC提高值≥10dB为90.9%,ABG≤20dB为54.5%;B组术后AC提高值≥10dB为51.9%,ABG≤20dB为22.1%。慢性中耳炎两组术后AC提高值及ABG经独立样本t检验,P<0.05,具有统计学意义。结论完整鼓室的乳突开放式鼓室成形术较开放式鼓室成形术听力提高效果满意,干耳时间相似,但要选择适合病例。

Objective To discuss two different approaches in chronic otitis media and middle ear cholesteatoma surgery and compare their hearing results. Methods We retrospectively reviewed 97 patients （99 ears） with chronic otitis media and middle ear cholesteatoma from January 2005 to May 2007. Among them, 22 ears were treated by intacttympanic mastoidectomy with tympanoplasty （ITM, group A）, and 77 ears by the open-cavity technique （OCT, group B）. The two groups were compared and analyzed based on the air-bone gap（ABG） and the average value of preoperative and postoperative hearing outcomes. Results The follow-up lasted six to thirty-four months. The dry ear rate of the 99 ears treated was 93.9% （93/99）, the recurrence rate of cholesteatoma was 7.0% （5/71）. The postoperative air-conduction hearing improvement（≥ 10 dB） and air-bone gap closure（ABG≤ 20 dB） were 60.6% and 29.3%, respectively. In group A they were 90.9% and 54.5%, respectively, in comparison to 51.9% and 22.1%, respectively in group B. The independent sample t test was used to compare them in patients with chronic otitis and the P value was less than 0.05, indicating a statistical significance. Conclusion Our study shows that ITM is more effective than OCT in improving hearing, but they have roughly the same time for obtaining a dry ear. However, we must choose the surgical method suitable for different conditions.