不同镫骨手术治疗鼓室硬化症的安全性及远期疗效分析

Analysis of the safety and long-term efficacy of different stapes surgeries in the tratment of tympanosclerosis

目的探讨不同镫骨手术治疗鼓室硬化症的安全性及远期疗效。方法回顾性分析1992年2月至2014年10月于西安交通大学第二附属医院耳鼻喉头颈外科接受镫骨手术的鼓室硬化症患者415例（453耳）的临床资料,所有患者均随访半年以上且随访资料完整,其中,镫骨钻孔活塞术134例（147耳）,镫骨切除术142例（155耳）,镫骨撼动术139例（151耳）,采用Stata 7.0软件进行相关数据统计分析。以气导听阈增加15 d B以上或达到应用听力水平为判定镫骨手术成功的标准。结果镫骨钻孔活塞术术后1、5年内气导平均听阈〈15 d B的患者分别占97.3%、95.1%;镫骨切除术术后1、5年内气导平均听阈〈15 d B的患者分别占96.8%、95.4%;镫骨撼动术术后1、5年内气导平均听阈〈15d B的患者分别占97.4%、95.3%。三种镫骨手术术后0.5、1、2、5、10年以上总成功率分别为51.0%（231/453）、45.6%（197/432）、41.3%（158/383）、35.5%（94/265）、25.5%（35/143）。镫骨钻孔活塞术、镫骨切除术、镫骨撼动术术后半年成功率分别为62.6%、46.5%、44.4%。术后随访0.5~19年,各阶段语言频率气导平均听阈（以阈值30 d B为标准）10年内无明显下降,而10年后下降较显著（P〈0.05）;随访前10年各阶段气导听阈增进皆以镫骨钻孔活塞术最高,以镫骨撼动术最低,差异具有显著性（P〈0.05）。随访10年以上各阶段气导听阈增进无明显差异（P〉0.05）。结论镫骨手术治疗鼓室硬化症安全性高,对气导听阈的影响较小。由于三种镫骨手术术后10年的远期疗效皆有所下降,因此选择合适的镫骨手术方式对于维持患者术后远期疗效具有重要意义。

Objective To discuss the safety and long-term efficacy of different stapes surgeries in the tratment of tympanosclerosis patients. Method Retrospectively analyzed the data of 415 tympanosclerosis patients（involving 453 ears） in Second Affiliated Hospital of Xi＇an Jiaotong University who accepted different stapes surgeries from February 1992 to November 2014. All the patients were follow-uped for more than 6 months. The study involved drilling piston stapes surgery 134 cases（involving 147 ears）, stapedectomy 142 cases（involving 155 ears）, and shake stapes surgery 139 cases（involving 151 ears）. Used Stata 7.0 software to make a relevant statistical analysis. Regard air conduction hearing threshold increased 15 d B or reaching the hearing level as the success criteria stapes surgery. Result Compared the postoperative air conduction hearing threshold of 3 kinds of surgeries, the air conduction hearing threshold less than 15 d B of drilling piston stapes surgery after 1 year was 97.3%, in 5 years was 95.1%; the air conduction hearing threshold less than 15 d B of stapedectomy after 1 year was 96.8%, and in 5 years was 95.4%; the air conduction hearing threshold less than 15 d B of shake stapes surgery after 1 year was 97.4%, and in 5 years was 95.3%, so the security of stapes surgery was satisfied. The total successful rate of 3 kinds of stapes surgeries of post-operation 6 months, 1, 2, 5 and 10 years were 51.0%（231/453）, 45.6%（197/432）, 41.3%（158/383）, 35.5%（94/265）, 25.5%（35/143）, respectively. Compared the 3 kinds of surgeries, drilling piston stapes surgery obtained the highest successful rate 6 months post-operation（62.6%）, followed by shake stapes surgery（46.5%）, and the last was stapedectomy（44.4%）. The average of hearing threshold of bone conduction was steadily within the first 10 years, but had a sharply decrease after that（P〈0.05）. The air conduction hearing threshold of each stage in the first 10 years about all increased most in drilling piston stapes surgery, and increased least in shake stapes surgery, the difference was significantly（P〈0.05）. There were no significantly differences in threshold improving after 10 years（P〉0.05）. Conclusion The safety of stapes surgery in the treatment of tympanosclerosis has more effectiveness and less impact on air conduction threshold. However, the long-term efficacy will decline after 10 years of all the 3 stapes surgeries. This suggests that to maintain the stability of postoperative long-term efficacy, it is important for doctors to select the appropriate stapes surgical approach.