耳内镜下鼓室成形术治疗慢性化脓性中耳炎鼓膜穿孔的疗效及听力恢复的相关因素分析  

Analysis of the Efficacy of Endoscopic Tympanoplasty in the Treatment of Tympanic Membrane Perforation in Chronic Suppurative Otitis Media and the Relate Factors of Hearing Recovery

作　　者：郭伟霞 陈伟东 刘男[1] 张玉龙 冀宏斌[1] GUO Wei-xia;CHEN Wei-dong;LIU Nan;ZHANG Yu-long;JI Hong-bin(Department of Otolaryngology,Handan First Hospital,Handan,Hebei,056000,China;Department of Otolaryngology,The 981st Hospital of the Joint Logistics Support Force of Chinese People's Liberation Army,Chengde,Hebei,067000,China)

机构地区：[1]邯郸市第一医院耳鼻喉科,河北邯郸056000 [2]解放军联勤保障部队第九八一医院耳鼻喉科,河北承德067000

出　　处：《现代生物医学进展》2024年第5期990-994,共5页Progress in Modern Biomedicine

基　　金：河北省医学科学研究计划项目(20231918)。

摘　　要：目的:探讨耳内镜下鼓室成形术(TUO)治疗慢性化脓性中耳炎鼓膜穿孔的疗效,并分析影响听力恢复的相关因素。方法:回顾性分析2020年3月~2022年3月期间在邯郸市第一医院接受治疗的218例慢性化脓性中耳炎鼓膜穿孔患者的临床资料。根据手术方式的不同将患者分为A组(n=108,接受传统手术治疗)和B组(n=110,接受TUO治疗)。对比两组疗效、听力恢复情况和并发症发生率。收集B组患者的临床资料,采用多因素Logistic回归模型分析影响听力恢复的相关因素。结果:B组的临床总有效率高于A组(P<0.05)。两组术后6个月气骨导差、骨导听阈、气导听阈下降,且B组低于A组(P<0.05)。两组并发症总发生率组间对比未见差异(P>0.05)。根据听力恢复情况分为良好组(n=75)和不良组(n=35)。单因素分析结果显示,听力恢复与咽鼓管、镫骨情况、鼓室黏膜、人工听骨材料、鼓膜张肌腱、听骨链有关(P<0.05)。多因素Logistic回归模型结果显示:听骨链病变、镫骨仅剩底板、咽鼓管不通畅、人工听骨材料为生物陶瓷、无鼓膜张肌腱是听力恢复的独立危险因素(P<0.05)。结论:TUO治疗慢性化脓性中耳炎鼓膜穿孔,可提高临床治疗效果,改善听力。听骨链病变、镫骨仅剩底板、咽鼓管不通、人工听骨材料为生物陶瓷、无鼓膜张肌腱为听力恢复的危险因素。Objective:To investigate the efficacy of endoscopic tympanoplasty(TUO)in the treatment of tympanic membrane perforation in chronic suppurative otitis media,and analyze the relate factors affecting hearing recovery.Methods:218 patients with chronic suppurative otitis media with tympanic membrane perforation who were treated in Handan First Hospital from March 2020 to March 2022 were retrospectively analyzed.Patients were divided into group A(n=108,receiving traditional surgical treatment)and group B(n=110,receiving TUO treatment)according to the different surgical methods.The efficacy,hearing recovery and complication rate were compared between two groups.The clinical data of patients in group B were collected,and the relate factors affecting hearing recovery were analyzed by multivariate Logistic regression model.Results:The total clinical effective rate in group B was higher than that in group A(P<0.05).The air-bone gap,bone conduction hearing threshold and air conduction hearing threshold in two groups decreased 6 months after operation,group B was lower than that of group A(P<0.05).There was no difference in the total incidence of complications between two groups(P>0.05).Patients were divided into good group(n=75)and poor group(n=35)according to the hearing recovery.Univariate analysis showed that,hearing recovery was related to eustachian tube,stapes,tympanic mucosa,artificial ossicular material,tensor tympani tendon and ossicular chain(P<0.05).The results of multivariate Logistic regression model showed that:ossicular chain lesions,stapes only remaining the bottom plate,eustachian tube obstruction,bioceramic artificial ossicular materials,and no tensor tympani tendon were the independent risk factors for hearing recovery(P<0.05).Conclusion:TUO treatment of chronic suppurative otitis media tympanic membrane perforation,which can improve the clinical treatment effect,improve hearing.Ossicular chain lesions,stapes only remaining the bottom plate,eustachian tube obstruction,bioceramic artificial ossicular materi

关 键 词：鼓室成形术 耳内镜 慢性化脓性中耳炎 鼓膜穿孔 疗效 听力恢复 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]