后天性中耳胆脂瘤102例手术疗效分析

Analyses of the operative efficacy of 102 cases of acquired middle ear cholesteatoma

目的 探讨不同类型后天性中耳胆脂瘤手术治疗的效果.方法 回顾性分析2014年1-12月在中国医科大学附属第一医院首次手术的后天性中耳胆脂瘤患者,共102例（102耳）,其中上鼓室型中耳胆脂瘤60例,粘连型中耳胆脂瘤42例.所有患者术前均行纯音测听、颞骨CT及鼓膜像检查等.91例行开放式乳突切开＋鼓室成形术并同期行乳突腔充填（开放充填式组）,其中部分听骨赝复物（PORP） 47例,全部听骨赝复物（TORP） 35例,9例未行听骨链重建;1l例行完壁式乳突切开＋鼓室成形术（完壁式组）,均为PORP.患者术后随访12～ 24个月,记录最近一次随访的纯音测听和鼓膜像检查结果.采用PASW Stastistics 18.0软件对干耳时间及气骨导差（air-bone gap,ABG）进行统计学分析.结果 所有患者耳后切口均一期愈合,鼓膜愈合良好,平均干耳时间（5.4±1.7）周,无长期不干耳病例;上鼓室型干耳时间短于粘连型,差异具有统计学意义[（4.9±1.7）周vs（6.1±1.5）周,t=-3.52,P=0.001];完壁式组的干耳时间短于开放充填式组,差异具有统计学意义[（2.3±0.5）周vs（5.8±1.4）周,t=-8.43,P=0.000].93例行听骨链重建患者术前的ABG为（34.2±11.8）dB,术后为（19.0 ±5.5）dB,差异具有统计学意义（t=19.19,P=0.000）;上鼓室型胆脂瘤术前及术后ABG均小于粘连型,差异具有统计学意义（P值均＜0.05）.听骨链重建的患者中,无论术前还是术后,完壁式ABG均小于开放充填式（P值均＜0.05）.在乳突开放充填并行听骨链重建的病例中,PORP组ABG小于TORP组（P＜0.05）.结论 上鼓室型胆脂瘤术后干耳及听力改善均好于粘连型胆脂瘤.完壁式乳突切开＋鼓室成形术患者术后干耳及听力改善好于开放式乳突切开＋鼓室成形术并同期行乳突腔充填者.对于不适合完壁式的患者,施行开放充填式手术可以弥补术腔大、术后痂皮及分泌物不易清理的不足,有利于术后干耳及有效减少复发的可能,并同样可获得满意的听力改善效果.

Objective To investigate the efficacy of operations of acquired middle ear cholesteatoma.Methods Retrospectively analyzed clinical data of 102 patients whom received tympanoplasty with CWU or CWD with mastoid obliteration in our hospital between January 2014 and December 2014.Patients were divided into different groups according to types of the cholesteatoma as well as the different surgical procedures.Patients were followed up for 12-24 months,the pre and post-operative PTA was performed and evaluated.The post-operative hearing was assessed in terms of average ABG.Results The average dry ear time was （5.4 ± 1.7）weeks.The dry ear time of patients of attic cholesteatoma was shorter than those of tensa cholesteatoma [（4.9 ± 1.7） weeks vs （6.1 ± 1.5） weeks,t =-3.52,P =0.001];the dry ear time of patients underwent CWU was shorter than those underwent CWD with mastoid obliteration[（2.3 ± 0.5） weeks vs （5.8 ± 1.4） weeks,t =-8.43,P =0.000].Mean pre and post-operative air bone gaps in 93 ears underwent ossiculoplasty were （34.2 ± 11.8） dB and （19.0 ±5.5） dB respectively and these differences were statistically significant.Both the pre and post-operative air bone gaps of ears of attic cholesteatoma were smaller than those ears of tensa cholesteatoma（P 〈 0.05）.In the patients who underwent ossiculoplasty with CWD with mastoid obliteration,the post-operative air bone gaps of attic cholesteatoma were smaller than those of tensa cholesteatoma （P 〈 0.05）.Both the pre and post-operative air bone gaps of ears underwent CWU were smaller than those underwent CWD with mastoid obliteration（P 〈 0.05）.The post-operative air bone gaps of ears underwent PORP with CWD with mastoid obliteration were smaller than those underwent TORP with CWD with mastoid obliteration （P 〈 0.05）.Conclusions Both the hearing loss and the outcome of tensa cholesteatoma are worser than attic cholesteatoma.The outcome of PORP is better than TORP.The patients who will accept CWU should be selected more carefully and be followed up regularly.