| THE FIRST PART Clinical application analysis of wall-to-wall radical mastoidectomy with enlarged facial recess approach in middle ear cholesteatomaObjective: To investigate the clinical application effect and safety of wall-to-wall radical mastoidectomy with enlarged facial recess approach in middle ear cholesteatoma.Methods: 56 cases of middle ear cholesteatoma patients in our hospital from August 2015 to November 2019 were selected as the research object.Among them,28 patients from August 2015 to November 2017 were set as the control group,and they were given the open mastoid by microscope.Radical mastectomy + tympanoplasty,from December 2018 to November 2019,28 patients were set as the observation group,and they were given radical mastoidectomy with microscopically enlarged facial crypts + tympanoplasty;The surgical indicators,treatment effectiveness,and postoperative complications were compared between the two groups.Results: The operation time of the observation group(125.6±6.7 min)was significantly longer than that of the control group(105.3±7.2 min),but its dry ear rate(96.4%)was significantly higher than that of the control group(75.0%)(P<0.05),and the recurrence was less than The number of reoperation cases was lower than the control group(P>0.05).The effective rate of treatment in the observation group(96.4%)was significantly higher than that in the control group(71.4%)(P<0.05).The incidence of complications in the observation group(10.7%)was lower than that in the control group(21.4%),but the difference was not significant(P>0.05).Conclusion: The wall-to-wall mastoid with enlarged facial crypt approach has a high rate of radical treatment of dry ears,a low postoperative recurrence rate and complications,and a high effective treatment rate.It is worthy of clinical application.THE SECOND PART A clinical study on the effect of enlarged facial recess approach on middle ear cholesteatomaObjective: To investigate the clinical characteristics and the effect of surgical method on the curative effect of middle ear cholesteatoma with enlarged facial recess approach.Methods: A total of 90 cases of middle ear cholesteatoma patients admitted to our hospital from August 2015 to November 2019 were selected as the research objects.There were 34 male patients and 56 female patients,with an average age of(36.6±6.48)years old.According to different surgical methods,the subjects were divided into group A(complete wall radical mastoidectomy,n=30)and group B(complete wall radical mastoidectomy + tympanoplasty via microscope extended facial crypt)by random number table.N =30)and group C(open mastoid opening +tympanoplasty,n=30),there were no significant differences in general clinical data,disease history and audiological examination results.The operation,treatment effect,hearing and tinnitus results before and after surgery,shape change of external auditory canal,dry ear rate,survival rate of tympanic membrane healing,and incidence of postoperative complications in each group were statistically analyzed.Results: There were no significant differences in gender(male/female),age(years),course of disease(years),ear lesion(left/right)and preoperative pneumoskeletal conductance among all groups(P>0.05).There were statistically significant differences in intraoperative blood loss,operation time and postoperative hospital stay among the three groups(P<0.05),among which the intraoperative blood loss,operation time and postoperative hospital stay in group B were significantly lower than those in group A and GROUP C.In this study,the therapeutic effects of each group were compared.The total effective rate of group A was 70.00%,group C was 73.33%,and group B was 96.67%,with statistically significant differences compared with group A and GROUP C(P<0.05).There were no statistically significant differences in preoperative bone conductance threshold,air conductance threshold and air bone conductance difference among all groups(P>0.05).One year after surgery,the bone conduction threshold,air conduction threshold and air conduction difference of each group gradually decreased,among which,the bone conduction threshold,air conduction threshold and air conduction difference score of group C decreased more significantly,and the difference was statistically significant compared with group A and GROUP B(P<0.05).The THI values of all groups decreased after operation compared with before operation,but there was no statistical significance in the THI values of group A before and after operation(P>0.05),and there was statistical significance in the THI values of group B and group C before and after operation(P<0.05).The proportions of normal external auditory canal shape and small lumen in group C were 83.33% and 13.33%,respectively,and the difference was statistically significant compared with group A and GROUP B(P<0.05).The healing of eardrum and dry ear in group B were significantly better than those in group A and GROUP C,and the difference was statistically significant(P<0.05).The incidence and recurrence rates of complications were 33.33% and 23.33% in group A,6.67% and 3.33% in group B,and 13.33% and 10.00% in group C,respectively,with statistically significant differences(P<0.05).Conclusion: Compared with the mastoidectomy,the clinical effect and prognosis of the treatment of middle ear cholesteatoma are more significant by using the enlarged facial crypt and wall mastoidectomy plus tympanoplasty,which is worthy of clinical application. |
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