Quality of life assessment after endoscopic and microscopic myringoplasty using Chinese version of the Zurich chronic middle ear inventory
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摘要: 目的 利用汉化版苏黎世慢性中耳炎量表(ZCMEI)对耳内镜与显微镜下鼓膜成形术的疗效及患者生活质量改善情况进行评估与比较。 方法 选取2018年10月－2019年9月在北京大学第三医院耳鼻咽喉头颈外科行鼓膜成形术的慢性化脓性中耳炎患者97例，根据手术途径分为耳内镜组(40例)与显微镜组(57例)。在术前及术后3~9个月，采用汉化版ZCMEI对患者进行生活质量评估，并采用纯音听力检查进行客观评估。比较两组患者的手术时间、术中出血量、住院时间、鼓膜愈合率、并发症发生率、手术前后听力改善情况，特别对患者生活质量评分进行了前后比较。 结果 ① 耳内镜组在手术时间、总住院时间、术后住院时间方面均显著短于显微镜组，术中出血量显著低于显微镜组(P < 0.05)。②耳内镜组与显微镜组鼓膜愈合率分别为92.5%和98.2%，差异无统计学意义(P>0.05)；并发症发生率差异无统计学意义(P>0.05)，但耳内镜组未出现伤口周围麻木、疼痛症状。③耳内镜组(33例)、显微镜组(43例)患者术后平均气导听阈、气骨导差与术前相比均明显降低(P < 0.05)；广义线性模型分析结果显示，手术途径对术后气导听阈、术后气骨导差无影响(P>0.05)。④耳内镜组(32例)与显微镜组(48例)患者术后平均ZCMEI总分明显降低，其中中耳炎症状、主观听力水平、社会心理影响三项评分与术前评分相比显著降低(P < 0.05)，医疗资源使用评分无明显变化(P>0.05)。在单耳患者(71例)中，控制病程因素影响，耳内镜组与显微镜组ZCMEI总分及各单项评分差异无统计学意义(P>0.05)。 结论 从主观与客观指标综合评估，耳内镜下鼓膜成形术具有微创、手术时间短、恢复快的优势，且与传统显微镜下鼓膜成形术相比，术后听功能改善、鼓膜愈合率、并发症发生率以及患者生活质量改善均无明显差异。患者的生活质量评估在中耳炎疗效评价中具有重要意义，应综合关注患者主观体验与客观指标的改善情况，以获得最佳治疗效果。Abstract: Objective To assess and compare therapeutic effects and quality of life after endoscopic and microscopic myringoplasty using Chinese version of the Zurich chronic middle ear inventory(ZCMEI). Methods Patients with chronic suppurative otitis media underwent myringoplasty at the Third Hospital of Peking University from October 2018 to September 2019 were included in this study and divided into two groups: endoscopic tympanoplasty group(n = 40) and microscopic tympanoplasty group(n = 57). ZCMEI survey and pure tone audiometry were conducted preoperatively and 3-9 months postoperatively. The operation time, intraoperative blood loss, length of hospital, graft success rate, complication rate, hearing improvement and quality of life improvement were compared. Results ① The operation time, length of hospital and intraoperative blood loss of endoscopic group were significantly lower(P < 0.05). ②The graft success rate was 92.5% and 98.2%, respectively(P>0.05). The difference between the complication rate in two groups was not significant, but patients in endoscopic group had no symptoms of wound numbness or pain. ③Air conduction threshold(AC) and air-bone gap(ABG) were significantly lower after surgery in endoscopic group(n = 33) and microscopic group(n = 43). The analyzed result of generalized linear model indicated surgical approach had no influence on postoperative AC and ABG(P>0.05). ④The total scores of ZCMEI were significantly improved in endoscopic group(n = 32) and microscopic group(n = 48) postoperatively, as well as the scores of ear symptoms, hearing and psychosocial impact(P < 0.05). Preoperative and postoperative scores of medical resources were not significantly different in either groups(P>0.05). Controlling the course of disease, the total ZCMEI results and scores of each subscale in patients with single ear involved(n = 71) had no significant difference between two groups. Conclusion Endoscopic myringoplasty has the advantages of minimal invasiveness, short operation time, and quick recovery evaluated from subjective and objective aspects. Audiometry improvement, graft success rate, complication rate and quality of life improvements are comparable between endoscopic tympanoplasty and conventional microscopic tympanoplasty. The assessment of the quality of life is of great significance in efficacy evaluation of otitis media. Doctors should comprehensively consider patient's subjective experience and the objective improvement to obtain the best clinical efficacy.
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Key words:
- otitis media /
- myringoplasty /
- endoscopy /
- quality of life
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表 1 耳内镜组和显微镜组临床资料比较
因素 耳内镜组(n=40) 显微镜组(n=57) P 年龄/岁 42.7±14.6 44.0±13.0 0.626 性别(男: 女) 16:24 25:32 0.705 病程/月 126.9±157.6 212.5±174.7 0.006 双耳累及/例(%) 2(5.0) 18(31.6) 0.001 复发/例(%) 1(2.5) 2(3.5) 0.778 鼓室硬化/例(%) 3(7.5) 5(8.8) 0.823 手术侧别(左: 右) 21:19 34:23 0.484 中央型穿孔/例(%) 35(87.5) 49(86.0) 0.811 穿孔大小/cm 4.2±1.44 4.6±1.2 0.088 合并症a) 6(15.0) 9(15.8) 0.916 注：a)包括糖尿病、高血压、冠心病等系统性疾病。 
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表 2 耳内镜组和显微镜组手术及住院情况比较
组别 例数 手术时间/min 术中出血量/mL 住院时间/d 术后住院时间/d 耳内镜组 40 90.2±28.51) 3.0±2.01) 6.0±1.91) 3.0±1.31) 显微镜组 57 132.4±24.7 11.8±7.3 7.6±2.3 4.1±2.0 与显微镜组比较，1)P < 0.05。
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表 3 耳内镜组和显微镜组听力改善结果
dB 组别 例数 术前 术后 AC ABG AC ABG 耳内镜组 33 33.2±15.2 15.6±10.2 23.6±17.8 6.8±9.8 显微镜组 43 42.2±18.9 21.0±10.2 28.6±20.2 7.7±10.7 P ＜0.001 ＜0.001 0.266 0.402
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表 4 耳内镜组和显微镜组患者生活质量改善比较
组别 例数 总分 中耳炎症状 主观听力水平 社会心理影响 医疗资源使用 耳内镜组 32 术前 23.03±12.17 4.69±3.66 5.56±4.02 9.28±6.69 3.50±2.40 术后 10.06±7.861)2) 1.66±2.461) 3.22±3.311) 2.56±3.001)2) 2.63±2.20 显微镜组 48 术前 24.58±13.72 4.77±4.24 6.92±4.21 9.19±6.87 3.71±2.61 术后 15.02±10.891) 2.00±2.351) 4.27±3.461) 5.48±5.951) 3.27±2.59 与同组术前比较，1)P < 0.05；与显微镜组术后比较，2)P < 0.05。
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