完壁式乳突切除术联合鼓室成形术治疗慢性化脓性中耳炎的临床研究

Clinical study of complete wall mastoidectomy combined with tympanoplasty in the treatment of chronic suppurative otitis media

目的探讨完壁式乳突切除术(CWUM)联合鼓室成形术治疗慢性化脓性中耳炎(CSOM)患者的效果。方法选取2020年1月至2021年12月吉安市中心人民医院/上海市东方医院吉安医院收治的62例CSOM患者作为研究对象,按照手术方法不同分为对照组与观察组,每组31例。观察组行CWUM联合鼓室成形术,对照组行开放式乳突切除术联合鼓室成形术,比较两组听力指标、炎症因子水平、生命质量评分、治疗相关参数、视觉模拟评分法(VAS)评分、临床疗效、术后并发症发生情况。结果术后3个月,观察组骨导听阈、气导听阈及白细胞介素-8(IL-8)、降钙素原(PCT)、转化生长因子β1(TGF-β1)水平均低于对照组,生活受限、情感障碍、躯体症状评分均高于对照组,差异有统计学意义(P<0.05)。观察组术中失血量少于对照组,手术时间、住院时间均短于对照组,VAS评分低于对照组,差异有统计学意义(P<0.05)。观察组治疗总有效率为93.55%,高于对照组的74.19%,差异有统计学意义(P<0.05)。观察组术后并发症发生率为3.23%,低于对照组的19.35%,差异有统计学意义(P<0.05)。结论CSOM患者行CWUM联合鼓室成形术治疗效果显著,且创伤小、并发症少,值得临床推广应用。

Objective To investigate the clinical effect of complete wall mastoidectomy(CWUM)combined with tympanoplasty in the treatment of chronic suppurative otitis media(CSOM).Methods 62 CSOM patients admitted to Ji'an Central People's Hospital/Shanghai Oriental Hospital Ji'an Hospital from January 2020 to December 2021 were selected as the research subjects,and they were divided into the control group and the ob-servation group according to different of surgical methods,with 31 cases in each group.The observation group received CWUM combined with tym-panoplasty,control group received open mastoidectomy combined with tympanoplasty,the hearing index,inflammatory factor level,quality of life score,treatment related parameters,visual analogue scale(VAS)score,clinical efficacy and postoperative complications were compared between the two groups.Results 3 months after operation,the bone conduction threshold,air conduction threshold and the levels of interleukin-8(IL-8),procal-citonin(PCT)and transforming growth factor-β1(TGF-β1)in the observation group were lower than those in the control group,and scores of life limi-tation,emotional disorder and somatic symptoms were higher than those in the control group,and the differences were statistically significant(P<0.05).The intraoperative blood loss in the observation group was less than that in the control group,the operation time and hospital stay were shorter than those in the control group,and the VAS score was lower than that in the control group,the differences were statistically significant(P<0.05).The total effective rate in the observation group was 93.55%,which was higher than 74.19%in the control group,and the difference was statistically significant(P<0.05).The incidence of postoperative complications in the observation group was 3.23%,which was lower than 19.35%in the control group,the difference was statistically significant(P<0.05).Conclusion CWUM combined tympanoplasty in the treatment of CSOM patients has significant effect,with less trauma and complications,which is worthy of clinical promotion and application.