Application of Endoscope and Microscope in Tympanoplasty for Middle-aged and Young Patients with CSOM
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摘要:
目的 探究耳内镜与显微镜下鼓室成形术在中青年慢性化脓性中耳炎（chronic suppurative otitis media，CSOM）中的应用。 方法 选取2020年4月至2022年6月西藏自治区人民政府驻成都办事处医院收治的104例中青年CSOM患者，随机分为耳内镜组（n = 52）、显微镜组（n = 52）。比较2组手术前后听力情况、血管通透性相关因子[血小板活化因子（platelet activatingfactor，PAF）、纤维连接蛋白（fibronectin，Fn）]、疼痛程度（visual analogue scales，VAS评分）、睡眠质量（pittsburgh sleep quality index，PSQI评分）、炎症状态[转化生长因子-β1（transforming growth factor-β1，TGF-β1）、转化生长因子-β2（transforming growth factor-β2，TGF-β2）、白介素-8（interleukin-8，IL-8）、可溶性白细胞介素-2受体（soluble interleukin 2 receptor，sIL-2R）]及并发症。 结果 术后1个月、3个月，2组各频率气骨导差（air bone gap，ABG）比较，差异无统计学意义（P > 0.05）；耳内镜组术后1个月、3个月VAS、PSQI评分均低于显微镜组（P < 0.05）；耳内镜组术后1个月、3个月PAF水平低于显微镜组，Fn水平高于显微镜组（P < 0.05）；术后1个月、3个月，耳内镜组血清TGF-β1、TGF-β2、IL-8、sIL-2R均低于显微镜组（P < 0.05）；耳内镜组并发症发生率与显微镜组比较，差异无统计学意义（P > 0.05）。 结论 2种手术方式是中青年CSOM患者安全可靠的治疗方案，与显微镜手术相比，耳内镜下鼓室成形术后恢复时间更短，利于疼痛缓解，改善生活质量，并改善血管通透性，减轻机体炎症反应。 -
关键词:
- 化脓性中耳炎 /
- 耳内镜；显微镜；鼓室成形术 /
- 疼痛程度 /
- 炎症状态 /
- 并发症
Abstract:Objective To explore the application of otoscopic and microscopic tympanoplasty in the treatment of chronic suppurative otitis media （CSOM） in young and middle-aged patients, and provide a reference for clinical treatment. Methods A total of 104 young and middle-aged patients with CSOM admitted to Chengdu Office Hospital of the People’ s Government of the Xizang Autonomous Region from April 2020 to June 2022 were randomly divided into an Ear endoscopy group （52 cases） and a Microscope group （52 cases）. The two groups were compared in terms of pre- and post-operative hearing conditions, vascular permeability-related factors [platelet activating factor （PAF）, fibronectin （Fn）], pain intensity （visual analogue scales, VAS score）, sleep quality （Pittsburgh Sleep Quality Index, PSQI score）, inflammatory status [transforming growth factor-β1 （TGF-β1）, transforming growth factor-β2 （TGF-β2）, interleukin-8 （IL-8）, soluble interleukin 2 receptor （sIL-2R）], and complications. Results There was no significant difference in air bone gap （ABG） at each frequency between the two groups at 1 month and 3 months after surgery. （P > 0.05）. The VAS and PSQI scores in the Ear endoscopy group were lower than those in the Microscope group 1 month and 3 months after surgery （P < 0.05） . The PAF level in the Ear endoscopy group was lower and the Fn level was higher than that in the Microscope group 1 month and 3 months after surgery （P < 0.05）; serum TGF-β1, TGF-β2, IL-8, and sIL-2R levels were lower in the Ear endoscopy group than in the Microscope group 1 month and 3 months after surgery （P < 0.05）. There was no significant difference in the incidence of complications between the Ear endoscopy group and the Microscope group （P > 0.05）. Conclusion Both surgical methods are safe and reliable treatment options for young and middle-aged patients with CSOM. Compared with microscopic surgery, otic endoscopic tympanoplasty has a shorter recovery time, facilitates pain relief, improves quality of life, and improves vascular permeability, reducing the body's inflammatory response. -
图 1 2组手术前后听力ABG比较
A：频率为500 Hz手术前后ABG；B：频率为1000 Hz手术前后ABG；C：频率为2000 Hz手术前后ABG；D：频率为1000 Hz手术前后ABG。*P<0.05。
Figure 1. Comparison of hearing ABG before and after surgery between two groups
表 1 基线资料[n（%）/（$ \bar x \pm s $）]
Table 1. Baseline data[n（%）/（$ \bar x \pm s$）]
基线资料 耳内镜组（n＝52） 显微镜组（n＝52） χ2/t/u P 年龄（岁） 29.55±5.43 30.22±5.07 0.650 0.517 性别 0.346 0.556 男 28（53.85） 25（48.08） 女 24（46.15） 27（51.92） 病程（a） 2.98±0.84 3.21±0.62 1.589 0.115 患耳 0.347 0.556 右耳 29（55.77） 26（50.00） 左耳 23（44.23） 26（50.00） 纯音测听/气骨导差（ABG） 0.215 0.975 46～60 dB 3（5.77） 2（3.85） 36～45 dB 17（32.67） 17（32.69） 26～35 dB 32（61.54） 33（63.46） 
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表 2 2组手术前后听力ABG比较（$ \bar x \pm s $，dB）
Table 2. Comparison of hearing ABG before and after operation between the two groups （$ \bar x \pm s $，dB）
频率 组别 n 术前 术后1个月 术后3个月 F P 500 Hz 耳内镜组 52 35.80±3.61 20.34±2.15a 10.59±1.35a 1294.344 <0.001* 显微镜组 52 35.91±3.47 20.79±2.06a 10.71±1.43a 1369.209 <0.001* t 0.158 1.090 0.440 P 0.874 0.278 0.661 1000 Hz 耳内镜组 52 35.76±3.58 20.34±2.12a 10.12±0.89a 1435.709 <0.001* 显微镜组 52 35.59±3.61 20.68±2.25a 10.26±0.92a 1334.926 <0.001* t 0.241 0.793 0.789 P 0.810 0.430 0.432 2000 Hz 耳内镜组 52 34.16±5.28 20.39±2.34a 10.58±1.49a 615.293 <0.001* 显微镜组 52 34.33±5.31 20.71±2.57a 10.70±1.53a 590.872 <0.001* t 0.164 0.664 0.405 P 0.870 0.508 0.686 4000 Hz 耳内镜组 52 35.28±5.72 20.12±2.19a 10.64±1.73a 594.891 <0.001* 显微镜组 52 35.10±5.64 20.38±2.25a 10.02±1.95a 609.185 <0.001* t 0.162 0.597 1.051 P 0.872 0.552 0.296 与同组术前比较，aP < 0.05；*P < 0.05。
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表 3 2组手术前后血管通透性相关因子比较[（$ \bar x \pm s $），ng/mL]
Table 3. Comparison of vascular permeability-related factors between the two groups before and after surgery [（$ \bar x \pm s $），ng/mL]
因子 组别 n 术前 术后1个月 术后3个月 F P PAF（ng/mL） 耳内镜组 52 123.20±20.77 97.89±11.54a 92.62±10.41ab 61.954 <0.001* 显微镜组 52 121.43±20.91 108.85±12.52a 98.02±11.03ab 29.921 <0.001* t 0.433 4.642 2.568 P 0.666 <0.001* 0.012* Fn（mg/L） 耳内镜组 52 120.73±13.47 154.63±15.17a 181.92±22.84ab 157.080 <0.001* 显微镜组 52 123.42±15.10 140.70±16.21a 156.36±20.04ab 47.459 <0.001* t 0.959 4.525 6.066 P 0.340 <0.001* <0.001* 与同组术前比较，aP < 0.05；与同组术后1个月比较，bP < 0.05；*P < 0.05。
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表 4 2组手术前后VAS评分、PSQI评分比较（$ \bar x \pm s $，分）
Table 4. Comparison of VAS score and PSQI score before and after operation between the two groups （$ \bar x \pm s$，points）
评分 组别 n 术前 术后1个月 术后3个月 F P VAS评分 耳内镜组 52 5.52±1.22 2.61±0.50a 1.35±0.48ab 362.434 <0.001* 显微镜组 52 5.47±1.35 3.58±0.63a 2.84±0.52ab 115.251 <0.001* t 0.198 8.697 15.183 P 0.843 <0.001* <0.001* PSQI评分 耳内镜组 52 17.39±1.14 9.67±0.80a 6.08±0.75ab 2082.438 <0.001* 显微镜组 52 17.12±1.10 12.73±1.05a 10.36±0.79ab 624.958 <0.001* t 1.229 16.716 28.333 P 0.222 <0.001* <0.001* 与同组术前比较，aP < 0.05；与同组术后1个月比较，bP < 0.05；*P < 0.05。
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表 5 2组手术前后炎症状态比较（$ \bar x \pm s $）
Table 5. Comparison of inflammation status before and after surgery between the two groups （$ \bar x \pm s $）
指标 组别 n 术前 术后1个月 术后3个月 F P TGF-β1（μg/L） 耳内镜组 52 95.80±22.13 53.72±10.52a 43.61±8.48ab 177.766 <0.001* 显微镜组 52 93.75±26.43 68.65±12.47a 55.42±10.63ab 61.145 <0.001* t 0.429 6.599 6.263 P 0.669 <0.001* <0.001* TGF-β2（μg/L） 耳内镜组 52 15.70±3.88 9.65±1.92a 4.82±1.26ab 228.053 <0.001* 显微镜组 52 15.46±4.01 12.63±2.81a 8.56±2.10ab 66.116 <0.001* t 0.310 6.314 11.013 P 0.757 <0.001* <0.001* IL-8（ng/L） 耳内镜组 52 15.39±4.21 11.34±1.78a 6.35±1.27ab 142.127 <0.001* 显微镜组 52 15.74±4.02 12.25±2.45a 10.04±2.38ab 46.300 <0.001* t 0.434 2.167 9.864 P 0.666 0.033* <0.001* sIL-2R（U/mL） 耳内镜组 52 614.75±22.38 422.19±15.08a 382.47±14.69ab 2550.547 <0.001* 显微镜组 52 619.72±22.36 487.83±17.34a 419.68±15.82ab 1535.268 <0.001* t 1.133 20.598 12.429 P 0.260 <0.001* <0.001* 与同组术前比较，aP < 0.05；与同组术后1个月比较，bP < 0.05；*P < 0.05。
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