基于倾向评分匹配分析内淋巴囊手术治疗梅尼埃病的效果  

Effect analysis of endolymphatic sac surgery on Meniere’s disease based on propensity score matching

作　　者：司瑜[1,2] 卓师培 黄艳 何武辉 邓荆蔓[1,2] 楼锦涛 张志钢 SI Yu;ZHUO Shipei;HUANG Yan;HE Wuhui;DENG Jingman;LOU Jintao;ZHANG Zhigang(Department of Otolaryngology,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou 510030,Guangdong,China;Institute of Hearing and Speech,Sun Yat-Sen University,Guangzhou 510030,Guangdong,China)

机构地区：[1]中山大学孙逸仙纪念医院耳鼻喉科,广州510030 [2]中山大学听力与言语研究所,广州510030

出　　处：《中国临床医学》2025年第2期165-170,共6页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(82173154,82471155);广东省自然科学基金(2022A1515012436);中山大学临床研究5010计划(2024004)。

摘　　要：目的探究内淋巴囊手术(endolymphatic sac surgery,ESS)治疗梅尼埃病(Meniere’s disease,MD)的效果及预后意义。方法回顾性分析2009年1月至2023年8月在中山大学孙逸仙纪念医院住院治疗的MD患者274例。所有患者均接受生活方式管理和利尿剂等药物治疗。对初始治疗3~6个月效果控制不佳者进行鼓室内注射糖皮质激素(intratympanic glucocorticoid,ITG)或ESS治疗。治疗6个月后评估患者的眩晕控制分级和听力变化。通过倾向评分匹配(propensity score matching,PSM)调整干扰因素后,评估ESS对MD预后的影响。结果287例患者中,分别有194、80例进行了ESS、ITG治疗,匹配后两组各80例。PSM前后,ESS组眩晕控制达到A级患者的比例大于ITG组(P=0.004),两组患者听力保持差异无统计学意义。Kaplan-Meier曲线分析显示,ESS组中患者眩晕改善优于ITG组(P=0.029);两组听力保持差异无统计学意义。结论当MD患者保守治疗效果不佳时,选择ESS较ITG更有利于控制眩晕。Objective To analyse the clinical efficiency of endolymphatic sac surgery(ESS)in the management of Meniere’s disease(MD).Methods A retrospective analysis was conducted on 274 patients with MD who were hospitalized for treatment in Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University from January 2009 to August 2023.All patients received lifestyle management and drug treatment such as diuretics.For those whose conditions were not well controlled 3 to 6 months after the initial treatment,intratympanic glucocorticoid(ITG)or ESS treatment was carried out.Six months after the treatment,the classes of vertigo relief and hearing changes in the patients were evaluated.After adjusting the confounding factors through propensity score matching(PSM),the impact of ESS on the prognosis of MD patients was evaluated.Results Among 274 patients,194 and 80 patients underwent ITG and ESS,respectively.Eighty patients were enrolled into each group after PSM.Before and after PSM,the rate of patients reaching vertigo relief class A in ESS group was higher than that in the ITG group(P=0.004);there was no significant difference in hearing preservation between the two groups.Kaplan-Meier curve analysis showed that vertigo relief in the ESS group was better than that in the ITG group(P=0.029);there was no statistically significant difference in hearing preservation between the two groups.Conclusion When the initial treatment for patients with MD is ineffective,choosing ESS is more beneficial than ITG for controlling vertigo.

关 键 词：内淋巴囊手术 梅尼埃病 鼓室内注射 眩晕 

分 类 号：R764.33[医药卫生—耳鼻咽喉科]