微创及传统开放式鼓室成形术治疗慢性化脓性中耳炎的比较

目的 探讨微创及传统开放式鼓室成形术治疗慢性化脓性中耳炎对患者听力改善及耳积液可溶性白细胞介素-2受体（sIL-2R）、白细胞介素-8（IL-8）水平的影响。方法选取慢性化脓性中耳炎患者92例，根据手术方案分为微创组与传统组，各46例。传统组采取传统开放式鼓室成形术，微创组采取完璧式乳突根治术联合鼓室成形术。统计两组临床疗效、手术前后听阈平均值、耳积液sIL-2R及IL-8水平、应激反应指标［丙二醛（MDA）、超氧化物歧化酶（SOD）］水平、并发症，随访1～6个月统计疾病复发率。结果微创组总有效率（93.48%）高于传统组（78.26%）（P<0.05）；术后两组气导（AC）阈值较术前降低，且微创组低于传统组（P<0.05），两组骨导（BC）阈值与术前及组间比较差异无统计学意义（P>0.05）；术后1 d、术后3 d微创组sIL-2R、IL-8水平低于传统组（P<0.05）；术后1 d、术后3 d微创组MDA水平低于传统组，SOD水平高于传统组（P<0.05）；微创组并发症发生率（4.35%）低于传统组（17.39%）（P<0.05）；术后1、3、6个月微创组疾病复发率与传统组间比较差异无统计学意义（P>0.05）。结论微创术式治疗慢性化脓性中耳炎效果优于传统开放式鼓室成形术，可有效改善患者听力，调节sIL-2R及IL-8水平，应激反应程度较轻，术后并发症少。

Comparison of minimally invasive and traditional open tympanoplasty in the treatment of chronic suppurative otitis media

Objective To investigate the effect of minimally invasive and traditional open tympanoplasty on chronic suppurative otitis media on hearing improvement and and soluble interleukin-2 receptor (sIL-2R) and interleukin-8 (IL-8) levels in ear effusion. Methods Ninety two patients with chronic suppurative otitis media in our hospital were selected and divided into a minimally invasive group and a traditional group according to the surgical plan, with 46 cases in each. The traditional group adopted traditional open tympanoplasty, while the minimally invasive group adopted complete mastoid mastectomy combined with tympanoplasty. The clinical efficacy, average hearing threshold before and after operation, sIL-2R and IL-8 levels in ear effusion, stress response index, including malondialdehyde (MDA) and superoxide dismutase (SOD), and complications between the two groups were compared. The participants were followed up for 1 to 6 months. Results The total effective rate of the minimally invasive group (93.48%) was significantly higher than that of the traditional group (78.26%, P<0.05). After operation, the AC of the two groups were both significantly lower than those before the operation; and the minimally invasive group was significantly lower than that of the traditional group (P<0.05). There was no significant difference between the two groups in BC before or after the operation (P>0.05). The levels of sIL-2R and IL-8 in the minimally invasive group were significantly lower than those in the traditional group 1 and 3 days after surgery (P<0.05). The level of MDA in the minimally invasive group was significantly lower than that in the traditional group 1 and 3 days after surgery; and the level of SOD was significantly higher than that in the traditional group (P<0.05). The incidence of complications in the minimally invasive group (4.35%) was significantly lower than that in the traditional group (17.39%, P<0.05). There was no significant difference in disease recurrence rate between the minimally invasive group 1 month, 3 months or 6 months after operation compared with the traditional group (P>0.05). Conclusion The minimally invasive treatment of chronic suppurative otitis media is better than traditional open tympanoplasty. It can effectively improve patients′ hearing and adjust the levels of sIL-2R and IL-8. The degree of stress response is light and the postoperative complications are few.