乳突根治术联合软性外耳道后壁重建在中耳胆脂瘤手术中的应用价值  

Application of maaststoradical tomy combined with posterior wall of soft external auditory canal in middle ear cholesteatoma surgery

作　　者：刘利民 王冬青 吕怀庆[2] LIU Li-min;WANG Dong-qing;LYU Huai-qing(Department of Otorhinolaryngology,Affiliated Hospital of Qingdao University,Qingdao Shandong 266071,China;Department of Otolaryngology Head and Neck Surgery,Linyi People's Hospital,Linyi Shandong 276000,China)

机构地区：[1]青岛大学附属医院耳鼻咽喉科,山东青岛266071 [2]临沂市人民医院耳鼻咽喉头颈外科,山东临沂276000

出　　处：《临床和实验医学杂志》2023年第20期2215-2218,共4页Journal of Clinical and Experimental Medicine

基　　金：山东省医药卫生科技发展计划项目(编号:2016WS0592)。

摘　　要：目的研究乳突根治术联合软性外耳道后壁重建在中耳胆脂瘤手术中的应用价值。方法回顾性选取2019年1月至2021年2月青岛大学附属医院收治的102例中耳胆脂瘤患者作为研究对象,根据手术方法不同将患者分为对照组(n=50)和观察组(n=52)。对照组采用乳突根治术治疗,观察组采用乳突根治术联合软性外耳道后壁重建治疗。比较两组患者的干耳时间、术腔上皮化时间、术后24 h干耳率、外耳道情况、听力情况(听力提高、平均气导差、平均骨导差、平均听阀)、听力改善率、耳道功能良好率、鼓膜愈合率、术后1年胆脂瘤复发率及并发症发生情况。结果观察组患者干耳时间及术腔上皮化时间分别为(24.15±6.49)、(20.47±7.14)d,均短于对照组[(30.26±5.83)、(26.46±8.38)d],术后24 h干耳率为88.46%,高于对照组(64.00%),差异均有统计学意义(P<0.05)。观察组外耳道大腔、小腔患者比率分别为5.77%、5.77%,均低于对照组(26.00%、22.00%),外耳道中腔、正常患者比率分别为23.08%、65.38%,均高于对照组(8.00%、44.00%),差异均有统计学意义(P<0.05)。观察组患者听力提高、平均听阈分别为(21.38±2.44)、(23.15±2.84)dB,均高于对照组[(15.92±2.27)、(16.53±2.64)dB],气导差、骨导差比分别为(10.06±1.76)、(9.79±1.34)dB,均低于对照组[(14.89±1.66)、(15.02±1.49)dB],听力改善率为80.77%,高于对照组(60.00%),差异均有统计学意义(P<0.05)。两组患者耳道功能良好率及鼓膜愈合率比较,差异均无统计学意义(P>0.05)。观察组患者胆脂瘤复发率为3.85%,显著低于对照组(18.00%),差异有统计学意义(P<0.05)。观察组患者并发症发生率为7.69%,显著低于对照组(26.00%),差异有统计学意义(P<0.05)。结论与单纯乳突根治术相比,乳突根治术联合软性外耳道后壁重建治疗中耳胆脂瘤愈合时间更短,听力改善率更高,外耳道形态更好,复发率及并发症发生率更低,值得�Objective To study the value of mastoid radical resection combined with posterior wall reconstruction of soft external auditory canal in middle ear cholesteatoma surgery.Methods A total of 102 patients with middle ear cholesteatoma admitted to Affiliated Hospital of Qingdao University from January 2019 to February 2021 were retrospectively selected as the study subjects.According to different surgical methods,the patients were divided into the control group(n=50)and the observation group(n=52).The control group receiving mastoidectomy and the observation group receiving mastoidectomy combined with reconstruction of the posterior wall of the soft external auditory canal.The dry ear time,surgical cavity epithelialization time,the dry ear rate at 24 hours after surgery,external auditory canal condition,hearing condition(hearing improvement,average air conduction difference,average bone conduction difference,average auditory valve),hearing improvement rate,good ear canal function rate,tympanic membrane healing rate,postoperative 1-year recurrence rate of cholesteatoma,and incidence of complications were compared between the two groups of patients.Results The dry ear time and surgical cavity epithelialization time of the observation group patients were(24.15±6.49)and(20.47±7.14)days,respectively,which were shorter than those of the control group[(30.26±5.83)and(26.46±8.38)days],the dry ear rate at 24 hours after surgery was 88.46%,which was higher than that of the control group(64.00%),and the differences were statistically significant(P<0.05).The rates of patients with large and small external auditory meatus in the observation group were 5.77%and 5.77%,respectively,which were lower than those in the control group(26.00%and 22.00%),the rates of patients with medium and normal external auditory meatus were 23.08%and 65.38%,respectively,which were higher than those in the control group(8.00%and 44.00%),and the differences were statistically significant(P<0.05).The hearing improvement and average hearing threshold o

关 键 词：胆脂瘤 中耳 乳突根治术 软性外耳道后壁 听力情况 胆脂瘤复发率 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]