不做乳突切开的听骨链重建术对慢性中耳炎患者听力重建效果评价  

Effect of ossicular chain reconstruction without mastoidectomy on hearing in patients with chronic otitis media

作　　者：李春林[1] 张立涛[1] 唐世雄[1] 欧阳天斌[1] 张建华[1] 陈星[1] 李吉[1] 罗英[2] 杨春平[2] 杨影[2] 

机构地区：[1]浙江省宁波市第一医院耳鼻咽喉头颈外科,浙江宁波315000 [2]南昌大学第二附属医院耳鼻咽喉头颈外科,江西南昌330000

出　　处：《中国耳鼻咽喉头颈外科》2016年第9期518-520,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：江西省卫生厅科技计划资助项目(20101333)

摘　　要：目的探讨慢性中耳炎手术最佳方法。方法采集我院慢性中耳炎患者106例,评价不做乳突切开的听骨链重建术(术式1)与完壁式乳突开放听骨链重建术(术式2)的治疗效果、并发症及手术过程,并根据镫骨、咽鼓管、鼓膜张肌腱功能是否异常,采用logistic回归进行疗效分层分析。结果术式1和2的听力改善率分别为85.7l%、68.00%(x^2=4.73,P<0.05);治愈干耳率92.86%、88.00%(P>0.05);耳鸣持续率10.71%、18.00%(P>0.05);疼痛数字评分1~3分者85.71%和36.00%(x^2=29.56,P<0.0001);手术时间<2.0 h者89.29%和24.00%(x2=46.32,.P<0.0001)。分层分析显示正常人群中在镫骨、咽鼓管、鼓膜张肌腱功能,术式1相较于术式2而言,疗效OR分别是2.91、3.08和3.33;异常人群中OR分别为3.27和2.89、1.33。结论不做乳突切开的听骨链重建术,能达到提高听力目的,清除病灶,手术时间较短,是治疗部分中耳炎患者的一种合适手术选择。OBJECTIVE To investigate a better surgical treatment for chronic otitis media.METHODS106 patients with chronic otitis media were collected from hospital.We assessed effectss of ossicular chain reconstruction without incision of mastoid（method 1） and ossicular chain reconstruction with incision of mastoid（method 2）.We compared therapeutic effect,complication,and surgical treatment between these two groups.Furthermore,we performed stratification analysis by normal or abnormal function of stapes,Eustachian and tendon of tensor tympani,using logistic regression model.RESULTS The improvement of hearing by method 1 and 2 were85.71%,68.00%（P=0.0296）.The recovery rate of drying ear were 92.86%,88.00%（P=0.3931）.The proportion of continued tinnitus were 10.71%,18.00%（P=2827）.There were 85.71%and 36.00%samples with numeric pain score from 1 to 3（P〈0.0001）.There were 89.29%,24.00%samples with operation hour 2.0 hour（P〈0.0001）.For those patients with normal function of stapes,Eustachian and tendon of tensor tympani,the OR of method 1 were 2.91,3.08 and3.33 For those patients with abnormal function,the OR was 3.27,2.89 and 1.33.CONCLUSION Ossicular chain reconstruction without incision of mastoid is a suitable surgical treatment for chronic chronic otitis media,it could improve hearing more effectively with entire debridement of the focus and shorter operation time.

关 键 词：乳突 胆脂瘤 中耳 中耳炎 临床方案 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]