慢性化脓性中耳炎完壁术式与开放术式研究  

The clinical research on the canal wall up and canal wall down surgery in chronic suppurative otitis media

作　　者：宋昱[1] 马芙蓉[1] 

机构地区：[1]北京大学第三医院耳鼻咽喉头颈外科,北京100191

出　　处：《临床耳鼻咽喉头颈外科杂志》2012年第9期404-407,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：北京市自然科学基金(No:7112144);2008年度重大研究计划(No:908130322009);首都医学发展科研基金(No:2009-1040);2010国家自然科学基金(No:81070788);国家临床重点专科建设项目

摘　　要：目的:对慢性化脓性中耳炎完壁术式及开放术式的适应证、患者术后生活质量进行研究,为术式的选择提供参考。方法:对慢性化脓性中耳炎行完壁术式或开放术式患者的临床资料进行分析总结。采用纯音测听、声导抗术腔容积测定、耳内镜及慢性耳病调查量表(中文版)对患者进行追踪随访。结果:①术后干耳率完壁术式与开放术式分别为98.7%、98.6%(P>0.05);②干耳时间完壁术式为(40.1±21.2)d,开放术式为(53.5±15.0)d(P<0.05);③患侧耳道容积/对侧正常耳耳道容积完壁术式为1.16±0.10,开放术式为2.05±1.19(P<0.05);④慢性耳病调查量表得分完壁术式为(91.2±6.8)分,开放术式为(72.0±7.7)分(P<0.05);⑤术后认为耳道口扩大、影响外观者的比例,完壁术式为5.7%,开放术式为80.8%(P<0.05);⑥术后主观听力改善者完壁术式占58.9%,开放术式占24.2%(P<0.05);但纯音测听显示听阈及骨气导差2组差异无统计学意义(P>0.05);⑦术后满意度得分完壁术式、开放术式分别为9.55分和8.11分(P<0.05)。结论:①行完壁术式的患者耳道形态接近正常,干耳时间缩短,生活质量较开放术式有明显提高。②对于富有经验的耳科医生,完壁术式的适应证可以扩展至硬化型及板障型乳突、部分伴有解剖变异及有颅内外并发症的患者。Objective：To investigate on the Indication and quality of life of the canal wall up and canal wall down surgery in chronic suppurative otitis media,to provide reference for surgical options.Method：The clinical data of patients underwent canal wall up or canal wall down surgery are analyzed.Follow up on 312 patients are accomplished with pure tone audiometry,acoustic impedance for surgical cavity volume,ear endoscopy and the Chinese chronic ear survey（CCES）.Result：①The dry ear rate of canal wall up and canal wall down surgery are 98.7% and 98.6% respectively（P0.05）.②The average cavity epithelization and dry ear time are 40.1±21.2 days for canal wall up surgery and 53.5±15.0 days for canal wall down surgery（P0.05）.③The postoperative ear volume to the contralateral normal ear volume ratio are 1.16±0.10 for canal wall up surgery and 2.05±1.19 for canal wall down surgery（P0.05）.④Score of the CCES： 91.2±6.8 points for canal wall up surgery and 72.0±7.7 for canal wall down surgery（P0.05）.⑤The proportion of patients feeling change of ear appearance is 5.7% for canal wall up surgery and 80.8% for canal wall down surgery（P0.05）.⑥Hearing after surgery： objective hearing improvement rate is 58.9% for canal wall up surgery and 24.2% for canal wall down surgery（P0.05） according to the questionnaire,while the pure tone audiometry shows no significant difference in hearing thresh hold and air-bone gap.⑦The satisfactory score after surgery is 9.55 points for canal wall up surgery and 8.11 points for canal wall down surgery（P0.05）.Conclusion：①Patients underwent canal wall up surgery have near-normal external ear morphology,shorter dry ear time and much higher quality of life compared to canal wall down surgery.②For experienced ear surgeon,the indication for canal wall up surgery can be extended to cases with diploetic or sclerotic type of mastoid and part of the cases with anatomical variation and intracranial or extracranial complications.

关 键 词：中耳炎 伴渗出液 完壁术式 开放术式 手术适应证 生活质量 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]