咽鼓管探通在耳内镜下鼓室成形术中的临床价值研究

程建安; 席庆明; 童步升

doi:10.16766/j.cnki.issn.1674-4152.001811

咽鼓管探通在耳内镜下鼓室成形术中的临床价值研究

doi: 10.16766/j.cnki.issn.1674-4152.001811

1.
安徽医科大学滁州临床学院耳鼻咽喉头颈外科, 安徽滁州 239000
2.
安徽医科大学第一附属医院耳鼻咽喉头颈外科，安徽合肥 230000

基金项目:

安徽省自然科学基金 JK2014A120

详细信息

通讯作者:
程建安, E-mail: 706154963@qq.com

中图分类号: R764.21 R764.9
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- 被引次数: 0
出版历程
- 收稿日期: 2020-05-30
- 网络出版日期: 2022-02-19

The clinical value of Eustachian tube exploration in tympanoplasty under otoendoscopy

1.
NE.N.T. Department, Chuzhou Clinical College of Anhui Medical University, Chuzhou, Anhui 239000, China

摘要

摘要: 目的探讨并发咽鼓管功能障碍的慢性化脓性中耳炎鼓室成形术中咽鼓管探通的临床价值。方法选取2017年2月—2019年12月安徽医科大学滁州临床学院耳鼻喉科58例伴有咽鼓管功能障碍的慢性化脓性中耳炎并行鼓室成形术的患者, 通过随机数字表法随机分为观察组(29例)和对照组(29例)。观察组术中施行咽鼓管探通术，对照组则只做鼓室探查。评价2组术前及术后3个月、6个月在移植物存活率、咽鼓管功能情况，以及术前、术后听力改善情况。结果在术后3个月、6个月随访中, 观察组移植物存活率(分别为100%、100%)均高于对照组(分别为96.6%、96.6%)，但差异均无统计学意义(P>0.05)；观察组术后3个月、6个月ETDQ-7得分分别为(8.78±5.35)分、(9.64±5.76)分，对照组术后3个月、6个月ETDQ-7得分分别为(9.81±4.50)分、(10.30±5.16)分，2组患者评分均低于术前(均P < 0.001)，但6个月较3个月2组ETDQ-7得分均未再有显著改善，且2组间比较在术后2个时间点的差异无统计学意义(P>0.05)。术后听力情况：术后3个月、6个月，观察组纯音听阈分别是(19.9±10.5)dB HL、(20.5±8.8)dB HL，对照组纯音听阈分别是(25.6±9.2)dB HL、(26.6±10.3)dB HL，均好于术前，但6个月较3个月听力稳定，未再显著改善，观察组在术后2个时间点纯音听阈均好于对照组(P < 0.05)。结论咽鼓管在中耳炎的发病机制中扮演着重要的角色，鼓室成形术能否恢复中耳腔的良好传声，有赖于咽鼓管是否正常发挥功能。伴有咽鼓管功能障碍的慢性化脓性中耳炎鼓室成形术中行咽鼓管探通可提高患者的手术效果，咽鼓管是否能够探通可作为预后判断依据及术后处理的指征。
- 中耳炎 /
- 鼓室成形术 /
- 咽鼓管功能 /
- 耳内镜 /
- 咽鼓管功能障碍症状评分量表(ETDQ-7)
Abstract: Objective To investigate the clinical value of eustachian tube exploration in the tympanoplasty of chronic suppurative otitis media with eustachian tube dysfunction. Methods A total of 58 patients diagnosed with chronic suppurative otitis media with eustachian tube dysfunction and underwent tympanoplasty in the Department of Otorhinolaryngology, Chuzhou Clinical College, Anhui Medical University from February 2017 to December 2019 were enrolled in this study. They were randomly divided into observation (29 cases) and control (29 cases) groups by using a random-number table. Eustachian tube exploration was performed in the observation group, whereas only tympanum exploration was conducted in the control group. The graft survival rate, eustachian tube function, and hearing improvement before and after 3 and 6 months were evaluated. Results At 3 and 6 months after operation, the observation group (both 100%) was superior to the control group (both 96.6%) in graft survival rate, but no statistical difference (P>0.05) was observed. The eustachian tube dysfunction scale lowered in the observation group [the scores of eustachian tube dysfunction questionnaire (ETDQ-7) for and 3 and 6 months after operation were 8.78±5.35, and 9.64±5.76, respectively) than in the control group (the scores of ETDQ-7 for and 3 and 6 months after operation were 9.81±4.50, and 10.30±5.16, respectively), P < 0.001]. No significant difference was observed between the two time points and the two groups (P>0.05). 3 months, 6 months after operation, the hearing condition of the observation group [the pure tone average (PTA) were (19.9±10.5) dB HL and (20.5±8.8) dB HL respectively] and the control group [the PTA were (25.6±9.2) dB HL and (26.6±10.3) dB HL respectively] were improved(P < 0.001). But the hearing was stable after 3 months, and there was no significant difference in PTA difference compared with 6 months (P>0.05). Both 3 months and 6 months after operation, the pure tone threshold of observation group was better than that of the control group(P < 0.05). Conclusion Eustachian tube plays an important role in the pathogenesis of otitis media. Whether tympanoplasty can restore the sound transmission of the middle ear cavity depends on whether the eustachian tube functions are normal. The exploration of eustachian tube can improve the operative effect in the tympanoplasty of chronic suppurative otitis media with eustachian tube dysfunction. Whether the Eustachian tube can be penetrated may be used as the basis of prognosis and indication of postoperative treatment.
- Otitis media /
- Tympanoplasty /
- Eustachian tube function /
- Otic endoscope /
- Eustachian tube dysfunction questionnaire-7

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表 1 2组慢性中耳炎患者一般临床资料比较

组别	例数	年龄(x±s，岁)	侧别(例)
组别	例数	年龄(x±s，岁)	左	右
观察组	29	50.34±10.03	17	12
对照组	29	51.07±10.56	15	14
统计量		-0.268^a	0.624^b
P值		0.790	0.430
注：^a为t值，^b为χ²值。

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表 2 2组慢性中耳炎患者手术前后咽鼓管功能比较 (x±s，分)

组别	例数	咽鼓管ETDQ-7评分			F值	P值
组别	例数	术前	术后3月	术后6月	F值	P值
观察组	29	23.78±6.17	8.78±5.35	9.64±5.76	59.921	＜0.001
对照组	29	21.77±7.71	9.81±4.50	10.30±5.16	38.689	＜0.001
t值		1.096	-0.794	-0.460
P值		0.278	0.431	0.647

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表 3 2组慢性中耳炎患者手术前后听力情况 (x±s，dB HL)

组别	例数	纯音听阈			F值	P值	气骨导差			F值	P值
组别	例数	术前	术后3个月	术后6个月	F值	P值	术前	术后3个月	术后6个月	F值	P值
观察组	29	41.1±12.3	19.9±10.5	20.5±8.8	77.786	< 0.001	27.8±8.8	13.8±5.9	14.1±3.7	67.123	< 0.001
对照组	29	41.5±12.3	25.6±9.2	26.6±10.3	48.069	< 0.001	28.3±10.2	13.6±5.7	14.4±5.4	45.556	< 0.001
t值		-0.124	-2.196	-2.653			-0.200	0.132	-0.144
P值		0.902	0.032	0.024			0.842	0.896	0.901

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参考文献(16)

[1]	宗小芳, 胡国华, 黄江菊, 等. 慢性化脓性中耳炎患者咽鼓管功能及其影响因素分析[J]. 听力学及言语疾病杂志, 2020, 28(2): 165-167. doi: 10.3969/j.issn.1006-7299.2020.02.012
[2]	付玉, 张志钢. 咽鼓管功能障碍研究进展[J]. 国际耳鼻咽喉头颈外科杂志, 2017, 41(3): 145-149. doi: 10.3760/cma.j.issn.1673-4106.2017.03.006
[3]	张浩亮, 于锋, 吴云文. 咽鼓管功能障碍的慢性化脓性中耳炎治疗分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 72-75. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYU201902015.htm
[4]	温雨婷, 刘勇智. 软骨及软骨复合物在中耳鼓室成形术中的应用[J]. 中华耳科学杂志, 2020, 18(3): 591-595. doi: 10.3969/j.issn.1672-2922.2020.03.031
[5]	姜妍, 李江平, 王鹏举. 耳内镜下鼓室成形术鼓膜穿孔修复材料的比较[J]. 听力学及言语疾病杂志, 2019, 27(6): 623-625. doi: 10.3969/j.issn.1006-7299.2019.06.010
[6]	钟晓声, 范绍翀, 杨海弟. 耳内镜下鼓室探查和鼓室成形术可行性及疗效分析[J]. 中国耳鼻咽喉头颈外科, 2019, 26(7): 354-357. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT201907005.htm
[7]	魏林, 李华英, 禤子才. 内镜下鼓室成形术在慢性中耳炎患者中的应用[J]. 中国当代医药, 2020, 27(17): 145-147. doi: 10.3969/j.issn.1674-4721.2020.17.042
[8]	张浩亮, 于锋, 吴云文. 咽鼓管功能障碍的慢性化脓性中耳炎治疗分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 72-75. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYU201902015.htm
[9]	康尧杰, 张路. 初次与再次Ⅰ型鼓室成形术疗效分析[J]. 听力学及言语疾病杂志, 2020, 28(4): 399-402. doi: 10.3969/j.issn.1006-7299.2020.04.010
[10]	中华医学会耳鼻咽喉头颈外科学分会耳科学组, 中华耳鼻咽喉头颈外科杂志编辑委员会耳科组. 中耳炎临床分类和手术分型指南(2012)[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(2): 5.
[11]	马芙蓉, 柯嘉. 慢性化脓性中耳炎的分型与诊断治疗进展[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(16): 1225-1227. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201716002.htm
[12]	陆银萍, 徐家兔, 刘平, 等. 咽鼓管功能研究进展[J]. 中华耳科学杂志, 2020, 18(4): 797-801. doi: 10.3969/j.issn.1672-2922.2020.04.035
[13]	P ASHLEY WACKYM, JAMES B SNOW J R. Ballenger's otorhinolaryngology head and neck surgery[M]. 18th edition. SHELTON: PMPH-USA, 2016: 708-733.
[14]	中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会. 咽鼓管功能障碍专家共识[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(6): 406-409. doi: 10.3760/cma.j.issn.1673-0860.2018.06.002
[15]	赵然师, 钟时勋. 咽鼓管功能检测及咽鼓管球囊扩张术的研究进展[J]. 中华耳科学杂志, 2020, 18(1): 152-157. doi: 10.3969/j.issn.1672-2922.2020.01.026
[16]	闵小玲, 刘晓海. 咽鼓管功能障碍在慢性化脓性中耳炎患者中的发生情况分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2018, 26(1): 16-20. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJH201801006.htm