中耳胆脂瘤手术同期行咽鼓管球囊扩张的临床观察  

Clinical observation of simultaneous Eustachian tube balloon dilatation and surgical treatment of middle ear cholesteatoma

作　　者：龚辉成[1] 于锋[1] 焦粤龙[1] 王海涛[1] 张浩亮[1] GONG Hui-cheng;YU Feng;JIAO Yue-long;WANG Hai-tao;ZHANG Hao-liang(The 12th Peopley s Hospital of Guangzhou City , Guangzhou Otolaryngology-Head and Neck Surgery Hospital,Institute ofOtolaryngology-Head and Neck Surgery,Guangzhou Medical University,Guangzhou 510620,China)

机构地区：[1]广州市第十二人民医院广州市耳鼻咽喉头颈外科医院广州医科大学耳鼻咽喉头颈外科研究所

出　　处：《中国耳鼻咽喉颅底外科杂志》2019年第3期285-288,292,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：广州市科技计划项目(201607010375;20170420178)

摘　　要：目的评价改良完壁式乳突根治加鼓室成形术同期行咽鼓管球囊扩张治疗中耳胆脂瘤并咽鼓管功能障碍的临床疗效.方法选取中耳胆脂瘤并咽鼓管功能障碍患者共64例,所有患者术前通过正负压平衡试验、鼓室滴药、Valsalva动作难易程度评分均证实为咽鼓管功能障碍.将患者随机分为对照组和观察组,其中对照组36例,观察组28例,对照组改良完壁式乳突根治加鼓室成形术,观察组行改良完壁式乳突根治加鼓室成形术并同期咽鼓管球囊扩张,记录两组术前及术后咽鼓管功能问卷评分(ETDQ-7)、干耳时间、纯音电测听及鼓室导抗图检查结果,比较两组患者的治疗效果.结果所有患者成功接受手术,术后随访6个月至1年,术前ETDQ-7评分、Valsalva测试、正负压平衡试验及纯音电测听(4PTA)对照组和观察组无统计学差异(P>0.05);术后6个月对照组和观察组ETDQ-7评分、纯音测听(4PTA)阈值均较术前明显降低(P<0.05);术后6个月对照组和观察组ETDQ-7评分、纯音测听(4PTA)阈值、鼓室导抗图、鼓膜内陷征象及干耳时间两组对比差异有统计学意义(P均<0.05).结论咽鼓管功能不良是中耳胆脂瘤的一个重要因素,小样本随访发现改良完壁式乳突根治加鼓室成形术同期咽鼓管球囊扩张治疗中耳胆脂瘤并咽鼓管功能障碍的短期效果良好,但其远期疗效有待对更大样本进一步观察.Objective To investigate the efficacy of Eustachian tube balloon dilation administered simultaneously with modified intact canal wall mastoidectomy-tympanoplasty in patients with middle ear cholesteatoma and Eustachian tube dysfunction.Methods Data were collected from 64 patients(64 ears) with middle ear cholesteatoma and Eustachian tube dysfunction confirmed by positive and negative pressure balance test, Dripping of tympanum,Valsalva’s level of difficulty and thin temporal bone CT scan. The 64 patients were randomly divided to control group(n=36) and observation group(n=28). Modified intact canal wall mastoidectomy-tympanoplasty was adopted in the control group, and Eustachian tube balloon dilation was administered simultaneously with modified intact canal wall mastoidectomy-tympanoplasty in the observation group. Eustachian tube dysfunction questionnaire(ETDQ-7), dry ear time, pure tone audiometry and tympanogram were performed pre-and postoperatively. The therapeutic effect between the two groups was compared.Results Successful operation was achieved in all the patients, and the patients were followed up for 6 months to 1 year postoperatively. Before operation, the differences in the data of ETDQ-7, Valsalva’s score, tympanogram and pure tone audiometry between the control group and the observation group were statistically insignificant(all P>0.05). At 6 months after operation, ETDQ-7 and pure tone audiometry threshold were obviously reduced in both groups, while the differences in the data of ETDQ-7, tympanogram, pure tone audiometry, involution of tympanic membrane and dry ear time between the two groups were statistically significant(all P<0.05).Conclusion Eustachian tube dysfunction is an important factor in middle ear cholesteatoma. Follow-up results of this small sample indicate that modified intact canal wall mastoidectomy-tympanoplasty combined with Eustachian tube balloon dilation may yield good short-term effect on patients with middle ear cholesteatoma and Eustachian tube dysfunction. However,

关 键 词：中耳胆脂瘤 咽鼓管功能障碍 咽鼓管球囊扩张 疗效 

分 类 号：R739.61[医药卫生—肿瘤]