中耳胆脂瘤及慢性化脓性中耳炎患者乳突根治术中面神经裸露及危险因素分析

Comparative analysis of facial nerve dehiscence and related risk factors in mastoidectomy between chronic suppurative otitis media and middle ear cholesteatoma

目的总结中耳胆脂瘤及慢性化脓性中耳炎患者乳突根治术中的面神经裸露情况,并分析面神经裸露的相关危险因素。方法回顾性分析2015年1月-2019年12月行乳突根治术的1 016例患者的临床资料,均为单耳患者,其中中耳胆脂瘤683耳,慢性化脓性中耳炎333耳,总结其面神经裸露情况及分布部位;采用单因素与多因素Logistic线性回归的统计方法分析年龄、性别、病程、硬脑膜暴露、半规管骨质破坏、乙状窦暴露及病理类型等因素与乳突根治术中面神经裸露的关系。结果 1 016例患者中有294耳出现面神经裸露,面神经总裸露率为28.94%(294/1 016);面神经裸露最常见的部位是水平段(264/294,89.80%)。中耳胆脂瘤的面神经裸露率为32.50%(222/683),慢性化脓性中耳炎的面神经裸露率为21.62%(72/333),两者差异具有统计学意义(P=0.0 003)。单因素分析结果显示病理类型、脑膜暴露、术前面瘫、半规管骨质破损及乙状窦暴露均为面神经裸露的相关因素,而与病程、年龄及性别无明显相关。进一步多因素Logistic回归分析结果示:中耳胆脂瘤、半规管骨质破坏及术前面瘫为面神经裸露的危险因素,风险分别增高1.575倍(95%CI:1.141~2.176)、4.171倍(95%CI:2.579~6.746)及13.040倍(95%CI:2.793~60.872)。结论中耳胆脂瘤及慢性化脓性中耳炎患者均可出现面神经裸露,最常见的裸露部位为水平段。半规管骨质破坏、术前面瘫及中耳胆脂瘤是乳突根治术面神经裸露的危险因素。

Objective To evaluate the incidence, location and related risk factors of facial nerve dehiscence(FND) in mastoidectomy of patients with chronic suppurative otitis media(CSOM) and middle ear cholesteatoma.Methods Clinical data of 1016 ears(683 cholesteatoma and 333 CSOM) undergoing mastoidectomy from Jan 2015 to Dec 2019 were retrospectively studied. The incidence and location of FND, and the relationships between FND and its risk factors(patients’ age, gender, course of disease, dura exposure, semicircular canal dehiscence, preoperative facial paralysis and sigmoid sinus exposure) in CSOM and cholesteatoma were analyzed using univariate and multivariate logistic linear regression analyses.Results The total incidence of FND was 28.94%(294/1016), and the most common location was the horizontal segment(89.80%, 264/294). The incidences of FND in cholesteatoma and CSOM were 32.50%(222/683) and 21.62%(72/333) respectively, which had statistically significant difference(P=0.0003). Univariate analysis showed that pathologic type, dura exposure, preoperative facial paralysis, semicircular canal dehiscence, and sigmoid sinus exposure were related to FND, but course of disease,and patients’ age and gender had no significant correlation with FND. According to multivariate logistic linear regression analysis, cholesteatoma(OR=1.575, 95%CI: 1.141~2.176), semicircular canal dehiscence(OR=4.171, 95%CI: 2.579~6.746) and preoperative facial paralysis(OR=13.040, 95%CI: 2.793~60.872) were risk factors of FND.Conclusion FND may occur in both cholesteatoma and CSOM with the most common location of horizontal segment.Semicircular canal dehiscence, preoperative facial paralysis and cholesteatoma are risk factors of FND.