创建上鼓室气道防止中耳胆脂瘤术后复发的临床效果研究

Study on the Clinical Effect of Creating Upper Tympanic Airway to Prevent Recurrence of Middle Ear Cholestatoma after Operation

目的探讨创建上鼓室气道防止中耳胆脂瘤术后复发的临床效果。方法选取本院2015年7月—2020年12月住院手术病例27例(27耳)为研究对象,根据治疗方式的不同分成三组:①经典完璧组5例(5耳),采用完璧式乳突根治术,常规开放面隐窝,尽量后拱柱;②上鼓室切开组2例(2耳),不保留上鼓室外侧壁,切除后用软骨重建,保留听骨链完整;③开放缩窄式组20例(20耳),采用乳突根治术后同期鼓室成形。针对不同组应用不同手术方式前后的听力变化比较,此外随访6个月统计两组复发情况。结果经典完璧组患者术后纯音气骨间隙均值(ABG)低于开放缩窄式组(P<0.05);上鼓室切开组术后ABG低于开放缩窄式组(P<0.05);开放缩窄式组随访6个月复发率较其他两组高,但组间对比差异无统计学意义(P>0.05)。结论保证上鼓室通畅程度的术式有利于中耳及乳突的气体交换,提高患者的听力,同时减少胆脂瘤的复发可能性。

Objective To investigate the clinical effect of creating upper tympanic airway to prevent recurrence of middle ear cholesteatoma after operation.Methods A total of 27 patients(27 ears)admitted to our hospital from July 2015 to December 2020 were selected as the study subjects,and divided into three groups according to different treatment methods:①Classic group(5 ears),which underwent complete mastoidectomy,conventional open-face recess,and posterior arch column as far as possible;②The external lateral wall of the upper tympanic cavity was not preserved in 2 cases(2 ears)in the upper tympanic cavity incision group,which was reconstructed with cartilage after resection,and the ossicular chain was intact in all cases.③20 cases(20 ears)in the open constriction group were treated with tympanoplasty after radical mastoidectomy.The hearing changes of different groups before and after different surgical methods were compared,and the recurrence of the two groups was analyzed after 6 months of follow-up.Results The mean value of pure tone gas-bone space(ABG)in classic complete group was lower than that in open constriction group(P<0.05).The ABG in the upper tympanotomy group was lower than that in the open constriction group(P<0.05).The 6-month recurrence rate of the open narrowing group was higher than that of the other two groups,but there was no significant difference between the two groups(P>0.05).Conclusion The operation method to ensure the patency of the upper tympanum is beneficial to the gas exchange of the middle ear and the mastoid process,improve the hearing of patients,and reduce the recurrence possibility of cholestatoma.