外耳道胆脂瘤与中耳胆脂瘤临床特征差异性及术后复发影响因素分析

Analysis on the Difference of Clinical Features and the Influencing Factors of Postoperative Recurrence between Cholesteatoma of the Outer Ear Meatus and Cholesteatoma of the Middle Ear

目的:探讨外耳道胆脂瘤与中耳胆脂瘤临床特征差异性及术后复发影响因素。方法:回顾性选择2019年12月至2022年12月来我院诊治的胆脂瘤患者85例,所有患者均行耳内镜下手术治疗。收集85例患者指标并分析胆脂瘤患者术后复发的影响因素。结果:外耳道胆脂瘤患者的病程明显较中耳胆脂瘤患者短(P<0.05)。两组均顺利完成耳内镜手术,外耳道胆脂瘤耳内镜纯音测试显示耳道鼓膜完整,耳道上皮化好,鼓室导抗图为A、Ad型,0.5 kHz、1.2 kHz平均气骨导差<10 dB。中耳胆脂瘤耳内镜纯音测试显示未见胆脂瘤样病变,也未见分泌物,0.5 kHz、1.2 kHz平均气骨导差为(34.78±6.78)dB,患者听力改善不明显。85例患者术后随访12个月发现复发者14例,复发率为16.47%。胆脂瘤术后复发的危险因素为术腔引流不畅、吸烟史、病变组织清除不彻底、上鼓室外侧开放不全、后鼓室病变、患者未进行定期复查(P<0.05)。结论:外耳道胆脂瘤与中耳胆脂瘤导致的面神经骨管破坏位置有差异,中耳胆脂瘤患者耳内镜手术改善效果有限,上鼓室外侧开放不全、有吸烟史、术腔引流不畅、病变组织清除不彻底、后鼓室病变、患者未进行定期复查是胆脂瘤术后复发的危险因素。

Objective:To explore the differences in the clinical characteristics and the influencing factors of postoperative recurrence.Methods:Retrospectively selected 85 patients with cholesteatoma in our hospital from December 2019 to December 2022,and all patients underwent endoscopic ear surgery.85 patient indicators were collected and analyzed for factors influencing postoperative recurrence in patients with cholesteatoma.Results:The course of cholesteatoma of the external auditory canal was significantly shorter than that of patients with middle ear cholesteatoma(P<0.05).Both groups successfully completed ear endoscopic surgery.The pure sound test of external auditory canal cholesteatoma showed intact eardrum,good epithelium,tympanic conductivity was type A and Ad,and the mean airbone conductivity of 0.5 kHz,1.2 kHz was<10 dB.The pure sound test of middle ear cholesteatoma showed no cholesteatoma and no secretion,the mean 0.5 kHz,1.2 kHz was(34.78±6.78)dB,and the hearing improvement was not significant.85 patients followed for 12 months found 14 recurrence,with a recurrence rate of 16.47%.The risk factors for postoperative recurrence of cholesteatoma were poor operative cavity drainage,smoking history,incomplete removal of diseased tissue,incomplete lateral opening of the upper tympanum,posterior tympanic lesions,and no regular reviewof the patients(P<0.05).Conclusion:External ear canal cholesteatoma and middle ear cholesteatoma cause facial nerve bone canal damage location difference,middle ear cholesteatoma patients ear endoscopic surgery improvement effect is limited,on the lateral tympanic opening incomplete,have a history of smoking,cavity drainage,lesion tissue removal,after tympanic lesions,patients with not regular review is a risk factor of cholesteatoma postoperative recurrence.