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投稿时间：2024-10-25 网络发布日期：2025-10-20
投稿时间：2024-10-25 网络发布日期：2025-10-20
中文摘要: 目的 对比耳内镜下和显微镜下鼓室成形术治疗慢性中耳炎（COM）的临床疗效，以及对血清可溶性白细胞介素-2受体（sIL-2R）、白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）水平的影响。方法 前瞻性选择2022年1月至2023年12月在陕西省人民医院治疗的100例COM患者为研究对象，用随机数字表法分为显微镜组和耳内镜组各50例。显微镜组采用传统显微镜鼓室成形术治疗，耳内镜组采用耳内镜下鼓室成形术治疗，观察两组临床疗效、围手术期指标，比较两组手术前后听力指标（气导听阈、骨导听阈、气骨导差），血清sIL-2R、IL-8、TNF-α水平以及术后并发症发生率。结果 术后评价，耳内镜组的总有效率高于显微镜组（96.00% vs 84.00%，χ2=4.000，P=0.046）；与显微镜组比较，耳内镜组患者术中出血量少、手术时间与住院时间短，差异均有统计学意义（P <0.01）。术后，两组患者气导听阈、骨导听阈、气骨导差均较术前显著降低（P<0.05），且耳内镜组显著低于显微镜组［（23.42±3.28）dB vs（26.65±3.35）dB，t=4.872，P <0.01；（13.24±3.37）dB vs（15.02±3.31）dB，t=2.665，P=0.009；（10.18±3.24）dB vs（11.63±3.26）dB，t=2.231，P=0.028］；两组患者术后血清sIL-2R、IL-8及TNF-α水平均显著降低（P<0.05），且耳内镜组均低于显微镜组（P<0.05）。耳内镜组术后并发症总发生率低于显微镜组（8.00% vs 24.00%，P<0.05）。结论 耳内镜下鼓室成形术治疗COM能改善患者临床症状，有助于降低血清中sIL-2R、IL-8、TNF-α等炎症因子水平，加快术后恢复，且其安全性良好。
Abstract:Objective To compare the clinical efficacy of tympanoplasty under otoendoscope and microscope in the treatment of chronic otitis media（COM），and their influences on levels of serum soluble interleukin-2 receptor（sIL-2R），interleukin -8（IL -8）and tumor necrosis factor -α（TNF -α）. Methods A total of 100 COM patients treated inShaanxi Provincial People’??s Hospital from January 2022 to December 2023 were prospectively selected as the research objects，and were randomly divided into microscope group（n=50）and otoendoscope group（n=50）by the random number table method. The microscope group was treated with traditional microscope tympanoplasty，while the otoendoscope group was given otoendoscope tympanoplasty. The clinical efficacy and perioperative indexes of the two groups were observed，and the hearing indexes［air conduction threshold（ACT），bone conduction threshold（BCT），and air -bone gap（ABG）］，serum levels of sIL -2R，IL -8 and TNF -α before and after operation and the incidence of postoperative complications were compared between the two groups. Results Postoperative evaluation showed that the total effective rate of the otoendoscope group was superior tothe microscope group（96.00% vs 84.00%，χ2=4.000，P=0.046）. Compared with the microscope group，the patients in otoendoscope group had less intraoperative bleeding，shorter operation time and shorter hospitalization time，with statistically significant differences（P <0.01）. After surgery，the levels of ACT，BCT，and ABG of the patients in the two groups were significantly lower than those before operation（P<0.05），and the levels of ACT［（23.42±3.28）dB vs（26.65±3.35）dB，t=4.872，P <0.01］，BCT［（13.24±3.37）dB vs（15.02±3.31）dB，t=2.665，P=0.009］，and ABG［（10.18±3.24）dB vs（11.63±3.26）dB，t=2.231，P=0.028］in the otoendoscopic group were significantly lower compared to the microscopic group. After surgery，the serum levels of sIL-2R，IL-8 and TNF -α in the two groups were significantly lower（P<0.05），and those in the otoendoscopic group were lower than those in the microscopic group（P<0.05）. The total incidence of postoperative complications in the otoendoscopicgroup was lower than that of the microscopic group（8.00% vs 24.00%，P<0.05）. Conclusion Otoendoscope tympanoplasty can improve the clinical symptoms of patients with COM，help to reduce the levels of serum inflammatory factors such as sIL-2R，IL-8，and TNF-α，and accelerate the postoperative recovery，with good safety.
keywords: Tympanoplasty Otoendoscope Microscope Chronic otitis media Air-bone gap Bone conduction threshold Air conduction threshold Inflammatory factors
文章编号： 中图分类号：R764.21 文献标志码：A
基金项目:陕西省自然科学基础研究计划一般项目（2019JM-497）；陕西省人民医院科技发展孵化基金（2023YJY-45）
附件
| Author Name | Affiliation |
| JING Yang，WANG Yujuan，ZHANG Jin，LIN Pei，ZHANG Wen | Department of Otolaryngology,Shaanxi Provincial People's Hospital,Xi'an,Shaanxi 710061,China |
引用文本：
景阳，王宇娟，张瑾，蔺沛，张文.耳内镜下鼓室成形术治疗慢性中耳炎患者的疗效及对血清炎症因子水平的影响[J].中国临床研究,2025,38(10):1576-1579,1584.
景阳，王宇娟，张瑾，蔺沛，张文.耳内镜下鼓室成形术治疗慢性中耳炎患者的疗效及对血清炎症因子水平的影响[J].中国临床研究,2025,38(10):1576-1579,1584.