重组人表皮生长因子凝胶对胆脂瘤型中耳炎患者开放式乳突根治术后术腔上皮化的影响及术后复发的影响因素  

Effect of recombinant human epidermal growth factor gel on surgical cavity epithelization in patients with cholesteatoma otitis media after open radical mastoidectomy and its influencing factors for postoperative recurrence

作　　者：唐强[1] 阮标[2] 李书聆[2] 高竞逾 蒋中莉 梁绍伟[1] TANG Qiang;RUAN Biao;LI Shuling;GAO Jingyu;JIANG Zhongli;LIANG Shaowei(Department of Otorhinolaryngology Head and Neck Surgery,Chongqing Hechuan People′s Hospital,Chongqing 401520,China;Department of Otorhinolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan,China)

机构地区：[1]重庆市合川区人民医院耳鼻咽喉头颈外科,重庆市401520 [2]昆明医科大学第一附属医院耳鼻咽喉科,云南省昆明市650032

出　　处：《广西医学》2023年第14期1664-1670,共7页Guangxi Medical Journal

摘　　要：目的探讨重组人表皮生长因子(rh-EGF)凝胶对胆脂瘤型中耳炎(COM)患者开放式乳突根治术后术腔上皮化的影响,并分析术后复发的影响因素。方法选取322例行开放式乳突根治术的COM患者作为研究对象。将患者随机分为观察组(197例)和对照组(125例)。术后使用浸润过氢化可的松氯霉素滴耳液的耳科小纱条加压填塞对照组患者术腔,先使用浸润过rh-EGF的耳科小纱条附于观察组患者术腔,再采用上述方法进行填塞。比较两组患者术腔完全上皮化所需时间、治疗总有效率,以及术后并发症及复发的发生情况。根据复发情况将患者分为复发组和未复发组,采用COX比例风险回归模型分析COM患者开放式乳突根治术后复发的影响因素,并建立列线图预测模型。结果观察组术腔完全上皮化所需时间短于对照组,治疗总有效率高于对照组,术后并发症发生率及复发率低于对照组(均P<0.05)。COX比例风险回归模型分析结果显示,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、术腔引流不畅、术后未使用rh-EGF是COM患者开放式乳突根治术后复发的影响因素(均P<0.05),基于这些影响因素构建的列线图预测模型具有较好的区分度、准确度和有效性。结论开放式乳突根治术后使用rh-EGF可以缩短COM患者术腔完全上皮化所需时间,提高治疗总有效率,降低术后并发症发生率及复发率。COM患者开放式乳突根治术术后复发与吸烟史、病变组织清除不彻底、上鼓室外侧开放不全、后鼓室病变、术腔引流不畅、术后未使用rh-EGF有关。Objective To explore the effect of recombinant human epidermal growth factor(rh-EGF)gel on surgical cavity epithelization in patients with cholesteatoma otitis media(COM)after open radical mastoidectomy,and to analyze its influencing factors for postoperative recurrence.Methods A total of 322 COM patients undergoing open radical mastoidectomy were selected as the research subjects.Patients were randomly assigned to observation group(197 cases)or control group(125 cases).The control group received otological small gauze infiltrated with hydrocortisone and chloramphenicol ear drops to tightly fill the surgical cavity after operation,and the observation group received otological small gauze infiltrated with rh-EGF to adhere the surgical cavity firstly,and then the surgical cavity was filled based on the aforementioned method.Time for surgical cavity complete epithelization,total effective rate of treatment,and occurrence of postoperative complications and recurrence were compared between patients of the two groups.According to recurrence status,patients were divided into relapsed group or non-relapsed group,and the COX proportional hazard regression model was used to analyze the influencing factors for postoperative recurrence in COM patients after open radical mastoidectomy,and the nomogram prediction model was established.Results The observation group exhibited shorter time for surgical cavity complete epithelization,a higher total effective rate of treatment,and lower incidence rate of postoperative complications and recurrence rate as compared with the control group(all P<0.05).The results of COX proportional hazard regression analysis revealed that smoking history,incomplete clearance of lesion tissues,incomplete lateral opening of upper tympanum,posterior tympanum lesion,poor drainage of surgical cavity,and non-utilization of rh-EGF after operation were the influencing factors for recurrence of COM patients after open radical mastoidectomy(all P<0.05).The nomogram prediction model established based on these in

关 键 词：胆脂瘤型中耳炎 开放式乳突根治术 重组人表皮生长因子 术腔上皮化 疗效 复发 影响因素 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]