完壁式乳突根治术治疗中耳胆脂瘤术后残留或复发的影响因素分析

Analysis of the Influence Factors of Postoperative Residual or Recurrent Middle Ear Cholesteatoma Treated with Complete Wall Mastoidectomy

目的:探讨完壁式乳突根治术治疗中耳胆脂瘤术后复发的影响因素,为改善中耳胆脂瘤患者预后提供指导。方法:回顾性收集2012年1月—2022年1月在贵州医科大学附属医院进行完壁式乳突根治术治疗的100例中耳胆脂瘤患者的病历资料,包括术前乳突薄层CT、术中情况、术式、术后内镜复查及听力学检查、实验室检查等。依据术后是否发生残留或复发分为发生组(n=18)与未发生组(n=82)。采用logistic回归分析中耳胆脂瘤完壁式乳突根治术后残留或复发的影响因素。结果:发生组年龄≤12岁、乙状窦前移、后鼓室存在病变、采取单纯显微镜手术占比均高于未发生组,差异有统计学意义(P<0.05);logistic回归分析结果显示,年龄≤12岁、乙状窦前移、后鼓室存在病变、单纯显微镜手术是中耳胆脂瘤患者完壁式乳突根治术后残留或复发的危险因素(OR>1,P<0.05)。结论:中耳胆脂瘤患者在完壁式乳突根治术治疗后有一定的复发率,儿童复发率较成人高,乙状窦前移、后鼓室存在病变及单纯显微镜手术为完壁式乳突根治术后复发的危险因素。

Objective:To explore the influence factors of postoperative residual or recurrence of middle ear cholesteatoma treated with complete wall mastoidectomy,in order to provide guidance for improving the prognosis of patients with middle ear cholesteatoma.Method:The medical records of 100 patients with middle ear cholesteatoma who underwent complete wall mastoidectomy in Affiliated Hospital of Guizhou Medical University from January 2012 to January 2022 were retrospectively collected,including preoperative thin layer CT of mastoid process,intraoperative conditions,surgical methods,postoperative endoscopic review,audiology examination,laboratory examination.They were divided into occurrence group(n=18)and non-occurrence group(n=82)according to whether residual or recurrence occurred after surgery.logistic regression analysis was used to examine the influence factors of residual or recurrence after complete wall radical mastoidectomy for middle ear cholesteatoma.Result:The age≤12 years old,anterior displacement of the sigmoid sinus,presence of lesions in the posterior tympanic cavity,and simple microsurgery of the occurrence group were all higher than those in the non occurrence group,the differences were statistically significant(P<0.05).The results of logistic regression analysis showed that age≤12 years old,anterior displacement of the sigmoid sinus,presence of lesions in the posterior tympanic cavity,and simple microsurgery were risk factors for residual or recurrent middle ear cholesteatoma patients after complete mastoidectomy(OR>1,P<0.05).Conclusion:Patients with middle ear cholesteatoma has certain recurrence rate after complete mastoidectomy,with a higher recurrence rate in children compared to adults.The presence of lesions in the anterior sigmoid sinus and posterior tympanic cavity,as well as the use of microsurgery alone are risk factors for recurrence after complete mastoidectomy.