两种不同手术入路治疗耳道狭窄并复发性中耳胆脂瘤的临床疗效分析

Analysis of the therapeutic effect of two different surgical approaches for the treatment of recurrent middle ear cholesteatoma with ear canal stenosis

摘要:

目的 探讨耳内镜下耳道入路外翻外耳道皮瓣与显微镜乳突入路治疗耳道狭窄并复发性中耳胆脂瘤的临床疗效。方法 回顾性分析2021年6月—2024年1月在扬州大学附属苏北人民医院接受手术的60例(60耳)耳道狭窄并复发性中耳胆脂瘤患者的临床资料，其中采用耳内镜下耳道入路外翻外耳道皮瓣手术(耳内镜组)29例，显微镜乳突入路手术(显微镜组)31例，评估两种手术在治疗耳道狭窄并复发性中耳胆脂瘤的手术时间、术后疼痛、并发症与复发率。结果 耳内镜组与显微镜组的人口统计学、疾病特征、并发症、复发率间差异均无统计学意义(P＞0.05)。耳内镜组与显微镜组的手术时间、术后疼痛视觉模拟量表(VAS)评分有显著差异，耳内镜组用时更少，疼痛更轻，更具优势(P<0.05)。结论 耳内镜下外翻外耳道皮瓣治疗耳道狭窄并复发性中耳胆脂瘤是一种有效的手术方法，需由经验丰富的外科医师进行操作，其疗效与显微镜乳突入路手术相似，但用时更少，疼痛更轻。

Abstract:

Objective To investigate the clinical effect of endoscopic approach with eversion external auditory canal flap and microscopic mastoid approach for the treatment of recurrent middle ear cholesteatoma with ear canal stenosis.Methods Clinical data of 60 patients (60 ears) with recurrent middle ear cholesteatoma with ear canal stenosis who underwent surgery at the Northern Jiangsu People’s Hospital Affiliated to Yangzhou University from June 2021 to January 2024 were retrospectively studied. Of them, 29 cases underwent surgery via endoscopic approach with eversion external auditory canal flap (endoscopic group) and 31 underwent microscopic mastoid surgery (microscopic group). The operation time, postoperative pain, complications and recurrence rate in both groups were evaluated and compared.Results There were no significant differences in demographics, disease characteristics, complications, and recurrence rate between the two groups (P＞0.05). The differences in operation time and visual analogue scale scores of postoperative pain between the two groups were statistically significant (P<0.05), and the endoscopic group took less time, experienced less pain and had more advantages.Conclusions Endoscopic surgery with eversion external ear canal flap is an effective surgical method for the treatment of recurrent middle ear cholesteatoma with ear canal stenosis. Performed by an experienced surgeon, the efficacy of endoscopic approach is similar to that of endoscopic mastoid approach, with less operation time and less postoperative pain.