三种乳突根治术治疗胆脂瘤中耳炎疗效分析及术后胆脂瘤复发的处理措施

摘要

Objective To compare clinical efficacy of open radical mastoidectomy (ORM) and complete bi-style radical mastoid surgery (CRMS) and open radical mastoidectomy-mastoid tamponade(ORM-MT) treatment of cholesteatoma otitis media (COM), and explore treatment measures for cholesteatoma recurrence after surgery. Methods The 130 cases of COM patients were randomly divided into ORM group(46 cases), CRMS group (38 cases) and ORM-MT group (46 cases). The values of average air conduction hearing threshold value and Air-bone difference and recurrence rate during fol-low-up were compared. Results The values of average air conduction hearing threshold value and Air-bone difference in CRMS group after three months were significantly lower than ORM group (q=12.055, 7.761, P<0.01), the values of average air conduction hearing threshold value and Air-bone difference in CRMS group after three months were signifi-cantly lower than ORM group (q=8.764, 11.443, P<0.01). But CRMS group and ORM-MT group had no significant dif-ference (q=1.170, 0.575, P>0.05). Recurrence rate of ORM, CRMS and ORM-MT group was 5 ears (10.9%), 9 ears (23.7%) and 4 ears (8.7%), respectively. Recurrence rate of CRMS group was significantly higher than ORM group and ORM-MT group (χ2=6.640, 9.072, P<0.05). Conclusion CRMS and ORM-MT technique is superior in improving hear-ing function, but CRMS has a higher recurrence rate. Face higher neural crest and poor drainage patients should be performed radical mastoid surgery again.%目的：对比观察开放式乳突根治术(ORM)和完壁式乳突根治术(CRMS)和开放式乳突根治术伴乳突填塞术(ORM-MT)治疗胆脂瘤型中耳炎(COM)的临床疗效，并探讨术后胆脂瘤复发的原因及处理措施。方法将130例单耳患病的COM患者随机分为ORM组(46例)、CRMS组(38例)及ORM-MT组(46例)，比较三组患者平均气导听阈值和气骨导差值及随访期间胆脂瘤复发率。结果三组患者术前平均气导听阈值和气骨导差值比较，差异无统计学意义(P>0.05)；术后3个月CRMS组气导听阈值和气骨导差值均明显低于ORM组(q=12.055、7.761，P<0.01)，ORM-MT组气导听阈值和气骨导差值亦低于ORM组(q=8.764、11.443，P<0.01)；但CRMS组与ORM-MT组气导听阈值和气骨导差值比较则无统计学差异(q=1.170、0.575，P>0.05)；ORM、CRMS及ORM-MT组分别复发5耳(10.9%)、9耳(23.7%)、4耳(8.7%)，CRMS组复发率明显高于ORM组和ORM-MT组(χ2=6.640、9.072，P<0.05)。结论CRMS术、ORM-MT术在改善COM患者听力方面优于ORM术，但CRMS术后复发率较高，因此ORM-MT术最佳。对面神经嵴较高、引流不畅的胆脂瘤复发患者应行乳突再根治术。