完壁式乳突根治联合开放式鼓室成型手术对胆脂瘤型中耳炎患者听力学的影响

Effects of intact canal wall mastoidectomy combined with open tympanoplasty surgery on audiology in patients with chronic otitis media with cholesteatoma

目的探讨对胆脂瘤型中耳炎患者采用完壁式乳突根治联合开放式鼓室成型手术治疗的临床效果。方法 86例(86耳)胆脂瘤型中耳炎患者随机分为对照组和研究组,每组43例(43耳),对照组采用常规手术进行治疗,研究组采用完壁式乳突根治联合开放式鼓室成型术治疗,比较2组手术情况、听力恢复、鼓膜愈合及干耳情况。结果研究组手术时间、术后并发症明显低于对照组(P<0.05),研究组手术成功率达97.67%优于对照组的76.74%(P<0.05);2组术前气骨导差及气导听阀水平比较差异无统计学意义(P>0.05),2组术后气骨导差及气导听阀水平较术前明显改善(P<0.05),且研究组听力恢复程度明显优于对照组(P<0.05);随访6个月,研究组鼓膜愈合成活率、干耳率分别为93.02%、95.35%,明显优于对照组的74.42%、76.74%(P<0.05)。结论完壁式乳突根治联合开放式鼓室成型术对胆脂瘤型中耳炎疗效显著,可有效促进听力恢复,且术后并发症较少,安全可靠。

Objective To observe the therapeutic effects of intact canal wall mastoidectomy combined with open tympanoplasty surgery on chronic otitis media with cholesteatoma .Methods Eighty-six patients （86 ears） with chronic otitis media complicated by cholesteatoma were randomly divided into control group and observation group , with 43 patients （ 43 ears） in each group.The patients in control group were treated by routine operation ,however, the patients in observation group were treated by intact canal wall mastoidectomy combined with open tympanoplasty surgery .The therapeutic effects , operation time,postoperative complications , hearing recovery , healing of ear drum and dry ear status of patients were observed and compared between two groups .Results The operation time and postoperative complications in observation group were significantly lower than those in control group （ P〈0.05）.The surgical success rate in observation group was significantly higher than that in control group （ 97.67%vs 76.74%, P〈0.05）.Before operation there were no significant differences in the air bone conduction difference and air pilot valves between two groups before operation （ P〉0.05）,however, which were obviously improved in both groups after operation （ P〈0.05）,moreover, the hearing recovery degree in observation group was suprior to that in control group （ P〈0.05）.After 6-month follow-up, the survival rate of eardrum healing and and dry ear rate in observation group were 93.02% and 95.35%, respectively, which were significantly higher than those （74.42% and 76.74%） in control group （ P〈0.05 ）.Conclusion The therapeutic effects of intact canal wall mastoidectomy combined with open tympanoplasty surgery on chronic otitis media with cholesteatoma are quite obvious ,which can effectively promote auditory rehabilitation of patients ,with safety,reliability and fewer postoperative complications .