耳内镜微创治疗中耳胆脂瘤临床分析

Clinical analysis of minimally invasive otoscope treatment for middle ear cholesteatoma

目的探讨耳内镜微创治疗中耳胆脂瘤的可行性及临床效果。方法选取2017年6月~2018年12月普宁市人民医院耳鼻喉科收治的中耳胆脂瘤患者74例,采用随机数字表法分为对照组(n=37)及耳内镜组(n=37),对照组采用乳突切开鼓室成形术,耳内镜组采用耳内镜下鼓室成形术,术后3个月时比较两组患者术后鼓膜愈合情况、术前及术后气导、骨导听阈变化及并发症的发生情况。结果术后3个月,对照组鼓膜一期愈合率为94.6%,耳内镜组鼓膜一期愈合率为97.3%,两组鼓膜一期愈合率比较,差异无统计学意义(P> 0.05)。对照组临床有效率为78.4%,耳内镜组临床有效率为94.6%,耳内镜组临床有效率高于对照组,差异有统计学意义(P <0.05)。两组术前气导听阈及骨导听阈比较,差异无统计学意义(P> 0.05),两组术后气导听阈及骨导听阈均较术前降低,差异有统计学意义(P <0.05)。术后耳内镜组患者气导听阈及骨导听阈均低于对照组,差异有统计学意义(P <0.05)。两组术前气骨导听阈差比较,差异无统计学意义(P> 0.05),术后两组气骨导听阈差均较术前下降,差异有统计学意义(P <0.05)。耳内镜组并发症总发生率为8.11%,对照组并发症总发生率为32.4%,耳内镜组并发症总发生率低于对照组,差异有统计学意义(P <0.05)。结论内耳镜微创治疗中耳胆脂瘤能够更有效的促进患者听力恢复,减少手术创伤及并发症的发生,具有较好的临床效果。

Objective To explore the feasibility and clinical effect of minimally invasive otoscope treatment for middle ear cholesteatoma.Methods A total of 74 patients with middle ear cholesteatoma who were treated in the department of otolaryngology in our hospital from June 2017 to December 2018 were selected,and they were divided into the control group and the otoscope group using the random number table method,with 37 cases in each group.The control group was treated with mastoid-tympanoplasty,and the otoscope group was treated with tympanoplasty with endoscope.Three months after the operation,the postoperative tympanic membrane healing,the preoperative and postoperative changes of air and bone conduction auditory threshold and the occurrence of complications between the two groups were observed.Results 3 months after the operation,the primary tympanic membrane healing rate in the control group and the otoscope group were 94.6%and 97.3%,respectively,and the difference was not statistically significant(P>0.05).The clinical efficacy of the otoscope group and the control group were 94.6%and 78.4%,respectively,and the clinical efficacy of the otoscope group was higher than that of the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference between the two groups in preoperative air conduction auditory threshold and bone conduction auditory threshold(P>0.05).The postoperative air conduction auditory threshold and bone conduction auditory threshold of the two groups were lower than that before surgery,and the differences were statistically significant(P<0.05).The air conduction auditory threshold and bone conduction auditory threshold of the otoscope group were lower than those in the control group,and the differences were statistically significant(P<0.05);there was no difference in air and bone conduction auditory threshold between the two groups before operation(P>0.05);the air and bone conduction auditory threshold in both groups after operation were lower than those before operation,and the differences were statistically significant(P<0.05).The total incidence of complications in the otoscope group and the control group was 8.11%and 32.4%,respectively;the total incidence of complications in the otoscope group was lower than that in the control group,and the differences were statistically significant(P<0.05).Conclusion Minimally invasive otoscope for middle ear cholesteatoma can more effectively promote hearing recovery,reduce surgical trauma and complications,and has good clinical effects.