改良乳突根治术联合鼓室成形术治疗胆脂瘤中耳炎的效果及安全性

Efficacy and safety of modified radical mastoidectomy combined with tympanoplasty on otitis media with cholesteatoma

目的分析改良乳突根治术联合鼓室成形术治疗胆脂瘤中耳炎的疗效及安全性。方法回顾性纳入南阳市中心医院2019年1月至2020年12月收治的胆脂瘤型中耳炎患者64例,根据手术方式分为传统乳突根治术组(传统组)和改良乳突根治术与鼓室成形术联合治疗组(联合组),每组32例。比较两组患者术后6个月的临床疗效、外耳道形状变化、听力改善情况,以及术后并发症发生情况。结果术后6个月,联合组临床总有效率(93.75%,30/32)高于传统组(68.75%,22/32),P<0.05。联合组外耳道形状正常者比例(62.50%,20/32)高于传统组(31.25%,10/32),中腔患者比例(3.13%,1/32)低于传统组(21.88%,7/32),P<0.05。术后6个月,两组气导听阈、气骨导差水平均低于术前(P均<0.05),且联合组气导听阈、气骨导差水平低于传统组(P<0.05)。联合组术后并发症发生率(15.63%,5/32)低于传统组(46.88%,15/32),P<0.05。结论改良乳突根治术与鼓室成形术联合治疗胆脂瘤型中耳炎临床疗效较好,可有效降低患者的气导听阈和气骨导差水平,改善患者的听力水平,能够最大程度维持外耳道形状正常,保证外耳美观,且并发症发生率低,安全性较高。

Objective To analyze the efficacy and safety of modified radical mastoidectomy combined with tympanoplasty in the treatment of otitis media with cholesteatoma.Methods Sixty-four patients with otitis media with cholesteatoma admitted to Nanyang Central Hospital from January 2019 to December 2020 were included retrospectively.According to the operation methods,they were divided into traditional radical mastoidectomy group(traditional group)and modified radical mastoidectomy combined with tympanoplasty group(combined group),with 32 cases in each group.The clinical efficacy,shape changes of external auditory canal,hearing improvement 6 months after surgery,and postoperative complications were compared between the two groups.Results The total effective rate of combined group(93.75%,30/32)was higher than that of the traditional group(68.75%,22/32)6 months after treatment(P<0.05).The proportion of patients with normal external auditory canal shape in the combined group(62.50%,20/32)was higher than that in the traditional group(31.25%,10/32)6 months after surgery,and the proportion of patients with middle cavity(3.13%,1/32)in the combined group was lower than that in the traditional group(21.88%,7/32),P<0.05.In the two groups,the air conduction hearing threshold and air-bone conduction difference 6 months after surgery were significantly lower than those before surgery(all P<0.05),And the air conduction hearing threshold and air-bone conduction difference in the combined group were lower than those in the traditional group 6 months after surgery(P<0.05).The complication rate in the combined group(15.63%,5/32)was lower than that in the traditional group(46.88%,15/32)after surgery(P<0.05).Conclusions Modified radical mastoidectomy combined with tympanoplasty has a good clinical effect on otitis media with cholesteatoma.It can effectively reduce the air conduction hearing threshold and air-bone conduction difference,improve the patients’hearing level,and can maintain the normal shape of the external auditory canal to the greatest extent,with low complication rate and high safety.