中青年CSOM鼓室成形术中耳内镜与显微镜的应用  

Application of Endoscope and Microscope in Tympanoplasty for Middle-aged and Young Patients with CSOM

作　　者：代维 胡川 DAI Wei;HU Chuan(Dept.of Otorhinolaryngology Chengdu Office Hospital,Tibet Autonomous Region People’s Government,Chengdu Sichuan 610041,China)

机构地区：[1]西藏自治区人民政府驻成都办事处医院耳鼻咽喉科,四川成都610041

出　　处：《昆明医科大学学报》2024年第4期113-119,共7页Journal of Kunming Medical University

基　　金：四川省医学(青年创新)科研课题基金资助项目(S20008)。

摘　　要：目的探究耳内镜与显微镜下鼓室成形术在中青年慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)中的应用。方法选取2020年4月至2022年6月西藏自治区人民政府驻成都办事处医院收治的104例中青年CSOM患者,随机分为耳内镜组(n=52)、显微镜组(n=52)。比较2组手术前后听力情况、血管通透性相关因子[血小板活化因子(platelet activatingfactor,PAF)、纤维连接蛋白(fibronectin,Fn)]、疼痛程度(visual analogue scales,VAS评分)、睡眠质量(pittsburgh sleep quality index,PSQI评分)、炎症状态[转化生长因子-β1(transforming growth factor-β1,TGF-β1)、转化生长因子-β2(transforming growth factor-β2,TGF-β2)、白介素-8(interleukin-8,IL-8)、可溶性白细胞介素-2受体(soluble interleukin 2 receptor,sIL-2R)]及并发症。结果术后1个月、3个月,2组各频率气骨导差(air bone gap,ABG)比较,差异无统计学意义(P>0.05);耳内镜组术后1个月、3个月VAS、PSQI评分均低于显微镜组(P<0.05);耳内镜组术后1个月、3个月PAF水平低于显微镜组,Fn水平高于显微镜组(P<0.05);术后1个月、3个月,耳内镜组血清TGF-β1、TGF-β2、IL-8、sIL-2R均低于显微镜组(P<0.05);耳内镜组并发症发生率与显微镜组比较,差异无统计学意义(P>0.05)。结论2种手术方式是中青年CSOM患者安全可靠的治疗方案,与显微镜手术相比,耳内镜下鼓室成形术后恢复时间更短,利于疼痛缓解,改善生活质量,并改善血管通透性,减轻机体炎症反应。Objective To explore the application of otoscopic and microscopic tympanoplasty in the treatment of chronic suppurative otitis media(CSOM)in young and middle-aged patients,and provide a reference for clinical treatment.Methods A total of 104 young and middle-aged patients with CSOM admitted to Chengdu Office Hospital of the People’s Government of the Xizang Autonomous Region from April 2020 to June 2022 were randomly divided into an Ear endoscopy group(52 cases)and a Microscope group(52 cases).The two groups were compared in terms of pre-and post-operative hearing conditions,vascular permeability-related factors[platelet activating factor(PAF),fibronectin(Fn)],pain intensity(visual analogue scales,VAS score),sleep quality(Pittsburgh Sleep Quality Index,PSQI score),inflammatory status[transforming growth factor-β1(TGF-β1),transforming growth factor-β2(TGF-β2),interleukin-8(IL-8),soluble interleukin 2 receptor(sIL-2R)],and complications.Results There was no significant difference in air bone gap(ABG)at each frequency between the two groups at 1 month and 3 months after surgery.(P>0.05).The VAS and PSQI scores in the Ear endoscopy group were lower than those in the Microscope group 1 month and 3 months after surgery(P<0.05).The PAF level in the Ear endoscopy group was lower and the Fn level was higher than that in the Microscope group 1 month and 3 months after surgery(P<0.05);serum TGF-β1,TGF-β2,IL-8,and sIL-2R levels were lower in the Ear endoscopy group than in the Microscope group 1 month and 3 months after surgery(P<0.05).There was no significant difference in the incidence of complications between the Ear endoscopy group and the Microscope group(P>0.05).Conclusion Both surgical methods are safe and reliable treatment options for young and middle-aged patients with CSOM.Compared with microscopic surgery,otic endoscopic tympanoplasty has a shorter recovery time,facilitates pain relief,improves quality of life,and improves vascular permeability,reducing the body's inflammatory response.

关 键 词：化脓性中耳炎 耳内镜 显微镜 鼓室成形术 疼痛程度 炎症状态 并发症 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]