显微镜下乳突根治术联合Nd∶YAG激光治疗中耳胆脂瘤的临床疗效  

Evaluation on Combined Effect of Microscopically Radical Mastoidectomy and Nd∶YAG Laser on Middle Ear Cholesteatoma

作　　者：李钦委 汤黎 傅雪雯 张继民 LI Qinwei;TANG Li;FU Xuewen;ZHANG Jimin(Department of Otolaryngology,Heze Municipal Hospital,Shandong Province,Heze 274500,China)

机构地区：[1]山东省菏泽市立医院耳鼻咽喉科,菏泽市274000

出　　处：《中国激光医学杂志》2024年第4期202-207,共6页Chinese Journal of Laser Medicine & Surgery

摘　　要：目的探究显微镜下乳突根治术联合掺钕钇铝石榴石(neodymium-doped yttrium aluminum garnet laser,Nd∶YAG)激光治疗中耳胆脂瘤的临床疗效。方法选择2022年5月至2024年5月,中耳胆脂瘤患者100例,采用随机数字表法将其分为实验组和对照组,每组患者各50例。实验组采用显微镜下乳突根治术联合Nd∶YAG激光治疗,乳突表面骨质激光碳化功率20~30 W,胆脂瘤及乳突、鼓窦、上鼓室病变部位气化功率40 W;对照组单纯采用显微镜下乳突根治术治疗。术前、术后3个月,两组患者采用纯听力测试法测定骨导听力阈值和气导听力阈值评估听力变化;耳鸣残疾量表(tinnitus handicap inventory,THI)评估耳鸣情况,分值越高则耳鸣症状越严重;眩晕残障程度评定量表(dizziness handicap inventory,DHI)评估眩晕情况。依据鼓膜愈合、咽鼓管通畅度、耳部症状及纯音听力阈值改变情况判定临床疗效。术前、术后12 d,检测耳部炎症指标包括血清超敏-C反应蛋白(hypersensitive Creactive protein,hs-CRP)、丙二醛(malondialdehyde,MDA)和超氧化物歧化酶(superoxide dismutase,SOD)水平变化情况。记录并发症发生情况。结果术后3个月,与对照组比较,实验组骨导听力阈值和气导听力阈值、THI、DHI评分明显降低。术后12 d,与对照组比较,实验组hs-CRP和MDA炎症指标水平明显偏低,SOD水平明显偏高(P<0.05)。实验组中耳胆脂瘤患者总有效率(94.0%)明显高于对照组(74.0%)(P<0.05)。实验组并发症发生3例(占6.0%)明显低于对照组10例(占20.0%)(P<0.05)。结论中耳胆脂瘤患者实施显微镜下乳突根治术联合Nd∶YAG激光治疗可改善临床症状,降低炎症反应,减少并发症发生。Objective To explore the combined effect of microscopically radical mastoidectomy and Nd∶YAG laser therapy on middle ear cholesteatoma.Methods Totally 100 patients with middle ear cholesteatoma treated between May 2022 and May 2024 were selected and divided randomly into an experimental group(n=50)and a control group(n=50).The patients in the experimental group were treated jointly with microscopically mastoidectomy and Nd∶YAG laser.The laser carbonization power for the mastoid surface bone was 20-30 W,and the gasification power for the cholesteroma,mastoid,tympanic sinus and upper tympanic cavity was 40 W.The patients in the control group were given microscopically radical mastoidectomy.For the patients of both groups,bone conduction hearing threshold and air conduction hearing threshold were measured respectively via pure hearing tests,and tinnitus handicap inventory(THI)was used to assess tinnitus before and 3 months after the surgery.The higher the score was,the more serious the tinnitus symptom appeared.In addition,dizziness handicap inventory(DHI)was used to assess dizziness for both groups of patients.The clinical effect for the two groups of patients was determined according to the healing of eardrum,patency of eustachian tube,ear symptoms and the change of pure tone hearing threshold.The changes to the levels of such indicators of ear inflammation as serum hypersensitive C-reactive protein(hs-CRP),malondialdehyde(MDA)and superoxide dismutase(SOD)were detected before and 12 days after the surgery and the complications induced in the treatment were recorded.Results Three months after the operation,the bone and air conduction hearing threshold and THI and DHI score of the patients in the experimental group decreased more obviously than those of the patients in the control group.Twelve days after the operation,the levels of hs-CRP and MDA were significantly lower in the experimental group than in the control group,and the SOD level in the experimental group was apparently higher(P<0.05).The total number

关 键 词：激光 显微镜下乳突根治术 中耳胆脂瘤 炎症指标 临床疗效 

分 类 号：R616.4[医药卫生—外科学] R764.2[医药卫生—临床医学]