Analysis of medium and long term efficacy of ossicle chain bypass technique in treatment of tympanosclerosis
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摘要: 目的 应用听骨链短路技术治疗伴有听骨链固定的鼓室硬化患者，评价分析手术中远期疗效。方法 回顾2017年6月至2019年6月于银川市第一人民医院接受耳内镜中耳手术的鼓室硬化患者147例，根据所实施的手术方案将研究对象分为3组，即听骨链松解术(OCM)组51例，听骨链短路技术(OCB)组56例，锤砧复合体切除听骨链重建术(MICR)组40例，通过为期3年的术后随访，对比分析不同手术方案的中远期疗效。结果 3组在术后鼓膜再穿孔、迟发性面神经麻痹、人工听骨排出及移位发生率比较差异无统计学意义。术后鼓膜内陷袋形成或胆脂瘤的发生率比较，OCB组(0)显著优于OCM组(11.76%)和MICR组(7.5%)(P < 0.05)。使用ΔABG来评价术后气骨导差的改善程度，术后12个月OCB组及MICR组均优于OCM组(P < 0.05)。术后36个月OCB组ΔABG高于OCM组(P < 0.05)，OCB组与MICR组在术后36个月ΔABG比较，差异无统计学意义。上鼓室型鼓室硬化(ETS)患者术后12、24及36个月听力学表现优于后鼓室型(PTS)及全鼓室型鼓室硬化(TTS)(P < 0.05)。结论 接受短路技术听骨链重建手术的鼓室硬化患者，相较于接受听骨链松解术以及锤砧复合体切除听骨链重建手术的患者，其听力预后在中远期表现更加优秀且稳定。该技术可以有效预防鼓室硬化患者术后鼓膜内陷袋形成及胆脂瘤的发生。Abstract: Objective For tympanosclerosis patients with ossicular chain fixation, we use ossicular chain bypass technique and evaluate its long-term effects.Methods From June 2017 to June 2019, 147 patients with tympanosclerosis who underwent middle ear surgery with otoscopy in Yinchuan First People's Hospital were reviewed. The subjects were divided into three groups according to the implemented operation plan, 51 cases in the ossicular chain mobilization group(OCM), 56 cases in the ossicular chain bypass reconstruction group(OCB), and 40 cases in the malleus-incus complex resection reconstruction group(MICR). Through a three-year follow-up, the medium and long-term effects of different operation plans were compared and analyzed.Results There was no significant difference among the three groups in the incidence of tympanic membrane perforation, delayed facial nerve palsy, and the dispatch and displacement of PORP. The incidence of tympanic membrane retraction pocket or cholesteatoma after operation in OCB group(0) was significantly lower than that in OCM group(11.76%) and MICR group(7.5%)(P < 0.05). At 12 months after operation, ΔABG of OCB group and MICR group were better than that in the OCM group(P < 0.05). At 36 months after operation, ΔABG of OCB group was better than that in the OCM group(P < 0.05), and there was no significant difference between OCB group and MICR group. The audiological performance of patients with epitympanic sclerosis(ETS) at 12, 24 and 36 months after operation was better than that of patients with posterior tympanosclerosis(PTS) and total tympanosclerosis(TTS)(P < 0.05).Conclusion Compared with patients undergoing ossicular chain mobilization and malleus-incus complex resection for ossicular chain reconstruction, patients with tympanosclerosis undergoing bypass technique have better and stable hearing prognosis in medium and long term. This technique can effectively prevent the formation of retracted pocket and cholesteatoma in patients with tympanosclerosis after operation.
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表 2 患者术后并发症发生情况
例(%) 并发症 OCM组
(51例)OCB组
(56例)MICR组
(40例)鼓膜再穿孔 3(5.88) 1(1.79) 2(5.00) 迟发性面神经麻痹 1(2.01) 0 1(2.50) PORP排出 - 3(5.36) 3(7.50) PORP移位 - 5(8.92) 3(7.50) 鼓膜内陷袋或胆脂瘤 6(11.76)1) 0 3(7.50)1) 与OCB组比较，1)P < 0.05。 
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