耳内镜下不同Ⅰ型鼓室成形术治疗慢性化脓性中耳炎的效果及预后分析  

Effect and prognosis analysis of different endoscopic typeⅠtympanoplasty in the treatment of chronic suppurative otitis media

作　　者：吴映儒 徐莲[1] 李森[1] 沈亮[1] 周培玉 何霞[1] 向芹贤 WU Yingru;XU Lian;LI Sen;SHEN Liang;ZHOU Peiyu;HE Xia;XIANG Qinxian(Dazhou Integrated Traditional Chinese Medicine and Western Medicine Hospital,Dazhou 635000,Sichuan,China)

机构地区：[1]达州市中西医结合医院,四川达州635000

出　　处：《中国现代手术学杂志》2024年第6期502-508,共7页Chinese Journal of Modern Operative Surgery

基　　金：达州市科技计划项目(21ZDYF0026)。

摘　　要：目的比较耳内镜下脱细胞异体真皮与耳屏软骨-软骨膜Ⅰ型鼓室成形术治疗慢性化脓性中耳炎的效果,并分析术后听力不良的影响因素。方法选取我院2021年1月~2022年6月收治的慢性化脓性中耳炎患者138例138耳。按照修补材料的不同分为软骨组(行耳屏软骨-软骨膜Ⅰ型鼓室成形术)71例71耳和异体真皮组(行脱细胞异体真皮Ⅰ型鼓室成形术)67例67耳,随访12个月。比较两组手术时间、干耳时间、鼓膜愈合情况、手术前后的气骨导差、气导听阈,不良反应发生情况以及预后听力不良的危险因素。结果与异体真皮组比较,软骨组手术时间明显延长(P<0.001),但干耳时间、鼓膜愈合率无明显统计学差异(P>0.05)。气骨导差及气导听阈术前两组比较无统计学差异(P>0.05),术后12个月,两组较之术前均明显降低,但两组之间无统计学差异(P>0.05)。两组均未合并中耳炎复发、鼓膜再穿孔、鼓室粘连等不良反应。经单因素分析,听力不良组(53例)与听力良好组(85例)在咽鼓管、鼓室黏膜、鼓膜张肌腱、人工听骨类型方面存在统计学差异(P<0.05);经二元logistic回归分析,鼓膜张肌腱位置异常、咽鼓管不通是术后听力不良的危险因素(P<0.05)。结论耳内镜下脱细胞异体真皮与耳屏软骨-软骨膜Ⅰ型鼓室成形术治疗慢性化脓性中耳炎的效果相当,均可有效促进鼓膜愈合,提高术后听力效果,但耳内镜下脱细胞异体真皮Ⅰ型鼓室成形术手术时间更短;术后听力不良和鼓膜张肌腱位置异常、咽鼓管不通有关。Objective To compare the effects of endoscopic typeⅠtympanoplasty using acellular allo-genic dermis or tragal cartilage-perichondrium in the treatment of chronic suppurative otitis media(CSOM),and to analyze the factors affecting postoperative hearing impairment.Methods From January 2021 to June 2022,138 patients with 138 CSOM ears were selected.According to different repair materials,they were divid-ed into the cartilage group of 71 cases 71 ears undergoing endoscopic tragal cartilage-perichondrium typeⅠtym-panoplasty and the allograft dermis group of 67 cases 67 ears undergoing endoscopic acellular allogeneic dermis typeⅠtympanoplasty.They were followed up for 12 months.The time of operation,dry ear time,the healing rate of tympanic membrane,preoperative and postoperative air-bone gap,air-conduction threshold,occurrence of adverse reactions were compared between the two groups,and risk factors of poor hearing was studied by logistic regression analysis.Results The operation time of the cartilage group was significantly longer than that of the allograft dermis group(P<0.001),and there was no significant difference in the dry ear time and the healing rate of tympanic membrane between two groups(P>0.05).Although there was no significant difference in air-bone gap and air-conduction threshold between the two groups before and after surgery(P>0.05),the 12-month postoperative results showed a significant decrease than before in both groups(P<0.05).There was no adverse reactions such as recurrent otitis media,re-perforation of the tympanic membrane,nor adhesion of the tympanic cavity.According to univariate analysis,terms of the eustachian tube,tympanic membrane mucosa,tensor tym-pani muscle tendon,and artificial auditory bone types were different in the poor hearing group(P<0.05).According to binary logistic regression analysis,malposition of the tensor tympani muscle tendon and obstruction of the eustachian tube were risk factors for poor hearing prognosis(P<0.05).Conclusion In the treatment of CSOM,the effect

关 键 词：耳内镜 脱细胞异体真皮Ⅰ型鼓室成形术 耳屏软骨-软骨膜Ⅰ型鼓室成形术 慢性化脓性中耳炎 预后 

分 类 号：R76[医药卫生—耳鼻咽喉科]