本文選題：中耳炎 + 鼓膜成形術(shù)��； 參考：《臨床耳鼻咽喉頭頸外科雜志》2017年19期

【摘要】：目的:分析慢性化膿性中耳炎行鼓膜成形術(shù)后的鼓膜穿孔率及聽力改善率,觀察術(shù)前中耳病變、咽鼓管功能及感染等不同狀態(tài)對術(shù)后療效的影響。方法:回顧性分析203例(203耳)行鼓膜成形術(shù)患者的臨床資料:根據(jù)術(shù)中探查鼓室內(nèi)有無膿性分泌物積聚,分為感染活動期組和感染靜止期組;根據(jù)術(shù)前聲導(dǎo)抗結(jié)果,分為咽鼓管功能不良組和咽鼓管功能良好組;根據(jù)術(shù)前顳骨HRCT提示中耳(乳突、鼓竇、鼓室)有無軟組織密度影,分為中耳無明顯病變組和中耳有局限病變組。術(shù)后3~6個月復(fù)查耳內(nèi)鏡和純音測聽,采用SPSS 19.0統(tǒng)計軟件比較不同組別術(shù)后鼓膜穿孔率和聽力改善率的差異。結(jié)果:單因素分析:(1)感染靜止期組術(shù)后鼓膜穿孔率為11.93%(13/109),高于感染活動期組[8.51%(8/94)];感染靜止期組術(shù)后聽力改善率為75.23%(82/109),低于感染活動期組[79.79%(75/94)],差異均無統(tǒng)計學(xué)意義(P0.05)。(2)咽鼓管功能不良組術(shù)后鼓膜穿孔率為14.06%(9/64),高于咽鼓管功能良好組[4.04%(4/99)],差異有統(tǒng)計學(xué)意義(P0.05);咽鼓管功能不良組術(shù)后聽力改善率為76.56%(49/64),低于咽鼓管功能良好組[81.82%(81/99)],差異無統(tǒng)計學(xué)意義(P0.05)。(3)中耳無明顯病變組術(shù)后鼓膜穿孔率為9.09%(10/110),低于中耳有局限病變組[11.83%(11/93)];中耳無明顯病變組的術(shù)后聽力改善率為78.18%(86/110),高于中耳有局限病變組[76.34%(71/93)],差異均無統(tǒng)計學(xué)意義(P0.05)。多因素分析:(1)術(shù)前咽鼓管功能與術(shù)后鼓膜的穿孔率有明顯的相關(guān)性(P0.05),術(shù)前感染狀態(tài)及顳骨HRCT影像提示的中耳病變情況與術(shù)后鼓膜的穿孔率均不存在明顯的相關(guān)性(P0.05)。(2)術(shù)前感染狀態(tài)、咽鼓管功能及顳骨HRCT影像提示的中耳病變情況與術(shù)后的聽力改善率均不存在明顯的相關(guān)性(P0.05)。結(jié)論:術(shù)前咽鼓管功能不良及中耳局限性病變多見于感染活動期;鼓室黏膜表面膿性分泌物積聚及中耳局限性病變不影響術(shù)后的鼓膜愈合率及聽力改善率;咽鼓管功能是影響術(shù)后鼓膜愈合率的一個重要因素,咽鼓管功能障礙者其術(shù)后鼓膜穿孔的可能性更大,但不影響術(shù)后的聽力改善率。
[Abstract]:Objective: to analyze the rate of tympanic membrane perforation and hearing improvement after tympanoplasty in patients with chronic suppurative otitis media. Methods: the clinical data of 203 patients with tympanoplasty were retrospectively analyzed. According to the intraoperative examination of purulent secretion accumulation in tympanic chamber, the patients were divided into two groups: active infection group and static infection group, according to the results of acoustic conductance before operation. According to HRCT of temporal bone before operation, soft tissue density of middle ear (mastoid process, tympanic sinus and tympanic chamber) was indicated, and divided into middle ear group without obvious lesion and middle ear with limited lesion group. Endoscope and pure tone audiometry were reexamined 3 ~ 6 months after operation. The differences of tympanic membrane perforation rate and hearing improvement rate in different groups were compared with SPSS 19.0 software. Results: univariate analysis showed that the rate of tympanic membrane perforation was 11.93% / 109 in the still stage group, which was higher than that in the active stage group [8.51% 8 / 94], and the hearing improvement rate in the still stage group was 75.23% 82109%, lower than that in the active stage group [79.79 75% 94], and there was no significant difference in the eustachian tube. The rate of tympanic membrane perforation in the dysfunctional group was 14.06 / 64, which was higher than that in the eustachian tube functional group [4.04 / 4 / 99], the difference was statistically significant (P 0.05), and the improvement rate of postoperative hearing in the dysfunctional eustachian tube group was 76.56 / 4964 / 64, which was lower than that in the eustachian tube functional group [81.82 / 89 / 99], with no statistical significance. The rate of tympanic membrane perforation was 9.09% (10 / 110) in the group with no obvious middle ear lesion, which was lower than that in the group with limited middle ear lesion [11.833%], and the improvement rate of hearing was 78.18% / 110 in the group without obvious lesion of middle ear, which was higher than that in the group with limited lesion of middle ear [76.3434% 71 / 93], and there was no significant difference (P 0.05%). Multivariate analysis: there was a significant correlation between the function of eustachian tube before operation and the perforation rate of tympanic membrane after operation (P 0.05). There was no significant correlation between the infection status before operation and the lesion of middle ear revealed by HRCT images of temporal bone and the perforation rate of tympanic membrane after operation. Infection status before operation, There was no significant correlation between the function of eustachian tube and HRCT images of temporal bone and the improvement rate of hearing after operation (P 0.05). Conclusion: preoperative dysfunctions of eustachian tube and localized lesions of middle ear are more common in the active stage of infection, the accumulation of purulent secretion on the surface of tympanic mucosa and localized lesions of middle ear do not affect the rate of tympanic membrane healing and hearing improvement after operation. The function of eustachian tube is an important factor affecting the healing rate of tympanic membrane after operation. The patients with dysfunctional eustachian tube are more likely to have perforation of tympanic membrane after operation, but have no effect on the improvement rate of hearing after operation.
【作者單位】： 新疆喀什地區(qū)第二人民醫(yī)院耳鼻咽喉頭頸外科;復(fù)旦大學(xué)附屬眼耳鼻喉科醫(yī)院耳鼻咽喉頭頸外科;
【分類號】：R764.9

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