中耳胆脂瘤患者手术方式选择与术后疗效分析

Analysis of surgical methods and outcome of middle ear cholesteatuma

目的通过对比不同手术方式的中耳胆脂瘤患者术后疗效,总结中耳胆脂瘤的手术方式及经验。方法回顾性分析手术并随访的中耳胆脂瘤患者的资料,按照不同手术方式分成三组,即A组(乳突根治术)、B组(开放式乳突切开+鼓室成形术)、C组(完壁式乳突切开+鼓室成形术),分析比较各组患者术后干耳时间、手术前后患者听力变化及手术前后耳鸣、眩晕等情况。结果 B组干耳时间较A组短,C组较A组干耳时间短,C组较B组干耳时间短,每组间两两比较差异有统计学意义。术后半年听力结果提示A组患者听力与术前比较差异无统计学意义,B组、C组较术前均有提高,差异有统计学意义。将三组患者术后气骨导差值两两比较,B组与A组的差异有统计学意义,C组与A组的差异有统计学意义,B组与C组的差异无统计学意义。三组手术前均有部分患者伴随耳鸣症状,手术后耳鸣残疾量表(THI)评分均较术前下降,A组手术前后THI值差异无统计学意义,B组、C组差异有统计学意义。A组、B组术前有部分患者伴随眩晕症状,两组手术后眩晕致残量表评分较术前均有下降,差异有统计学意义。结论中耳胆脂瘤患者各种手术治疗后均可有效去除病灶,实现干耳,改善眩晕。与乳突根治术相比,开放式乳突切开术+鼓室成形术和完壁式乳突切开术+鼓室成形术可以缩短术后干耳时间、提高患者术后听力,减轻耳鸣症状。

Objective To analyze the surgical methods and outcome of middle ear cholesteatuma. Methods Retrospective review was performed in 137 patients with middle ear cholesteatuma operated from Jan.2012 to Dec.2014.All the patients were divided into three groups according to different operation method, thus, group A （patients received mastoidectomy）, group B （patients received mastoidectomy and tympanoplasty with Canal Wall Down）, and group C （patients received mastoidectomy and tympanoplasty with Canal Wall Up） , and dry ear time and the change of hearing, tinnitus and vertigo were compared before and after surgery. Results A total of 137 patients with middle ear cholesteatoma were studied in this research, including 38 patients of group A, 76 cases of group B and 23 cases of group C. The dry ear time of Group B was shorter than group A, group C was shorter compared with group A, and group C was shorter than group B . The difference between each group was statistically significant. The hearing of group A six months after operation showed no statistically significant difference compared with preoperative, while those of group B and group C were increased, and the difference were statistically significant. Tinnitus disability scale THI （ tinnitus handicap inventory, THI） scores were reduced after operations, and the difference of group B and C group were statistically significant. There were some patients with vertigo symptom in group A and group B before surgery, and DHI scores after surgery （ deziness handicap inventory, DHI ） were dropped after operations, and the difference were statistically significant. Conclusion Compared with the mastoidectomy, mastoidectomy and tympanoplasty with Canal Wall Down and Canal Wall Up could shorten the dry ear time, improve the postoperative patients with hearing and relieve tinnitus symptoms postoperative in patients with middle ear cholesteatoma.