| 赵存尧,冯世斌,徐克素,周春桃,王 路.耳内镜与显微镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎的疗效比较及术后短期内听力恢复效果的影响因素分析[J].,2022,(18):3549-3553 |
| 耳内镜与显微镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎的疗效比较及术后短期内听力恢复效果的影响因素分析 |
| Comparison of Efficacy between Otoscope and Microscope Tympanoplasty Type I in the Treatment of Chronic Suppurative Otitis Media and Analysis of Influencing Factors of Short-Term Hearing Recovery after Operation |
| 投稿时间：2022-02-23 修订日期：2022-03-18 |
| DOI：10.13241/j.cnki.pmb.2022.18.028 |
| 中文关键词: 鼓室成形术 显微镜 耳内镜 慢性化脓性中耳炎 听力 疗效 |
| 英文关键词: Tympanoplasty Microscope Otoscope Chronic suppurative otitis media Hearing Efficacy |
| 基金项目:重庆市黔江区科技计划项目(黔科计2021026 )；重庆市医学科研项目（201430312） |
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| 中文摘要: |
| 摘要 目的：比较耳内镜与显微镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎的疗效，并分析术后短期内听力恢复效果的影响因素。方法：选取2019年3月~2022年2月期间我院收治的158例慢性化脓性中耳炎患者，均接受Ⅰ型鼓室成形术治疗，根据手术方式不同分为耳内镜组（81例）和显微镜组（77例），比较两组临床疗效及术后6个月的听力恢复不良发生率。收集相关资料，采用多因素Logistic回归分析术后短期内听力恢复效果的影响因素。结果：两组鼓膜穿孔发生例数组间对比无统计学差异（P>0.05）。耳内镜组的手术时间、住院时间短于显微镜组，术中出血量、医疗费用、干耳时间>1个月例数、耳廓麻木发生例数少于显微镜组（P<0.05）。耳内镜组、显微镜组术后6个月的听力恢复不良发生率组间对比无统计学差异（P>0.05）。单因素分析结果显示，慢性化脓性中耳炎患者术后6个月听力恢复效果与鼓室黏膜、鼓膜张肌腱、咽鼓管情况、是否鼓室硬化、听小骨周围是否肉芽包裹、术前鼓室内是否有脓性分泌物有关（P<0.05）。多因素Logistic回归分析显示，鼓膜张肌腱缺损、咽鼓管不通、鼓室硬化、听小骨周围肉芽包裹、术前鼓室内有脓性分泌物是慢性化脓性中耳炎患者术后短期内听力恢复不良的危险因素（P<0.05）。结论：与显微镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎相比，耳内镜下进行手术可缩短手术时间、住院时间，减少术中出血量和住院费用，降低并发症发生率。此外，患者术后短期内听力恢复效果受到鼓膜张肌腱、咽鼓管、鼓室硬化、听小骨周围肉芽包裹、术前鼓室内脓性分泌物等多种因素的影响。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the efficacy between otoscope and microscope tympanoplasty type I in the treatment of chronic suppurative otitis media, and to analyze the influencing factors of short-term postoperative hearing recovery. Methods: 158 patients with chronic suppurative otitis media who were admitted to our hospital from March 2019 to February 2022 were selected, all of whom were treated with tympanoplasty type I. According to different surgical methods, they were divided into otoscopy group (81 cases) and microscope group (77 cases), and the clinical efficacy and incidence of poor hearing recovery 6 months after operation were compared between the two groups. The related data were collected, and the influencing factors of short-term postoperative hearing recovery were analyzed by multivariate Logistic regression. Results: There was no statistical difference in the number of tympanic membrane perforation between the two groups (P>0.05). The operation time and hospital stay in otoscope group were shorter than those in microscope group, and the intraoperative blood loss, hospitalization expenses, cases with dry ear time >1 month and cases with auricle numbness were less than those in microscope group(P<0.05). There was no significant difference in the incidence of poor hearing recovery 6 months after operation between the otoscopy group and the microscope group(P>0.05). The results of univariate analysis showed that the hearing recovery effect 6 months after operation in patients with chronic suppurative otitis media was related to the tympanic mucosa, tendo musculi tensoris tympani, eustache tube condition, whether tympanic sclerosis, listen to whether the ossicle surrounded by granulation and whether purulent secretion in tympanic chamber before operation(P<0.05). Multivariate Logistic regression analysis showed that tendo musculi tensoris tympani defect, eustache tube impassability, tympanic sclerosis, listen to with the ossicle surrounded by granulation and purulent secretion in tympanic chamber before operation were the risk factors for poor hearing recovery in the short term after chronic suppurative otitis media (P<0.05). Conclusion: Compared with microscope tympanoplasty type I in the treatment of chronic suppurative otitis media, otoscope surgery can shorten the operation time, hospital stay, reduce the amount of intraoperative bleeding and hospitalization expenses, and reduce the incidence of complications. In addition, the short-term postoperative hearing recovery effect of patients is affected by many factors, such as tendo musculi tensoris tympani, eustache tube, tympanic sclerosis, listen to with the ossicle surrounded by granulation, purulent secretion in tympanic chamber before operation and so on. |
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