三种乳突根治术治疗胆脂瘤中耳炎疗效分析及术后胆脂瘤复发的处理措施  

Analysis of the efficacy of three radical mastoidectomy surgery treatment of cholesteatoma otitis media and explore treatment measures for cholesteatoma recurrence after surgery

作　　者：吴军武 肖芒[2] 金云飞[3] 

机构地区：[1]浙江省义乌市中医医院耳鼻咽喉科,浙江义乌322000 [2]浙江大学医学院附属邵逸夫医院耳鼻咽喉头颈外科,浙江杭州310016 [3]浙江省义乌市中心医院综合病区,浙江义乌322000

出　　处：《中国现代医生》2015年第2期62-64,67,共4页China Modern Doctor

基　　金：浙江省自然科学基金资助项目(Y2110410)

摘　　要：目的对比观察开放式乳突根治术(ORM)和完壁式乳突根治术(CRMS)和开放式乳突根治术伴乳突填塞术(ORM-MT)治疗胆脂瘤型中耳炎(COM)的临床疗效,并探讨术后胆脂瘤复发的原因及处理措施。方法将130例单耳患病的COM患者随机分为ORM组(46例)、CRMS组(38例)及ORM-MT组(46例),比较三组患者平均气导听阈值和气骨导差值及随访期间胆脂瘤复发率。结果三组患者术前平均气导听阈值和气骨导差值比较,差异无统计学意义(P>0.05);术后3个月CRMS组气导听阈值和气骨导差值均明显低于ORM组(q=12.055、7.761,P<0.01),ORM-MT组气导听阈值和气骨导差值亦低于ORM组(q=8.764、11.443,P<0.01);但CRMS组与ORMMT组气导听阈值和气骨导差值比较则无统计学差异(q=1.170、0.575,P>0.05);ORM、CRMS及ORM-MT组分别复发5耳(10.9%)、9耳(23.7%)、4耳(8.7%),CRMS组复发率明显高于ORM组和ORM-MT组(χ2=6.640、9.072,P<0.05)。结论 CRMS术、ORM-MT术在改善COM患者听力方面优于ORM术,但CRMS术后复发率较高,因此ORMMT术最佳。对面神经嵴较高、引流不畅的胆脂瘤复发患者应行乳突再根治术。Objective To compare clinical efficacy of open radical mastoidectomy （ORM） and complete bi-style radical mastoid surgery （CRMS） and open radical mastoidectomy-mastoid tamponade（ORM-MT） treatment of cholesteatoma otitis media （COM）, and explore treatment measures for cholesteatoma recurrence after surgery. Methods The 130 cases of COM patients were randomly divided into ORM group（46 cases）, CRMS group （38 cases） and ORM-MT group （46 cases）. The values of average air conduction hearing threshold value and Air-bone difference and recurrence rate during fol-low-up were compared. Results The values of average air conduction hearing threshold value and Air-bone difference in CRMS group after three months were significantly lower than ORM group （q=12.055, 7.761, P〈0.01）, the values of average air conduction hearing threshold value and Air-bone difference in CRMS group after three months were signifi-cantly lower than ORM group （q=8.764, 11.443, P〈0.01）. But CRMS group and ORM-MT group had no significant dif-ference （q=1.170, 0.575, P〉0.05）. Recurrence rate of ORM, CRMS and ORM-MT group was 5 ears （10.9%）, 9 ears （23.7%） and 4 ears （8.7%）, respectively. Recurrence rate of CRMS group was significantly higher than ORM group and ORM-MT group （χ^2=6.640, 9.072, P〈0.05）. Conclusion CRMS and ORM-MT technique is superior in improving hear-ing function, but CRMS has a higher recurrence rate. Face higher neural crest and poor drainage patients should be performed radical mastoid surgery again.

关 键 词：胆脂瘤型中耳炎 开放式乳突根治术 完壁式乳突根治术 开放式乳突根治术伴乳突填塞术 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]