Onal K, Uguz M Z, Kazikdas K C, Gursoy S T, Gokce H
First ENT Clinic, Atatürk Training and Research Hospital, Izmir, Turkey.
Clin Otolaryngol. 2005 Apr;30(2):115-20. doi: 10.1111/j.1365-2273.2004.00947.x.
The aim of this study was to evaluate the effects of smoking and other prognostic factors on long-term surgical outcome and hearing results in myringoplasty.
Retrospective cohort.
Tertiary medical centre.
Eighty myringoplasty operations were analysed retrospectively from the charts of 74 patients who underwent myringoplasty between January 2000 and November 2002 at the First ENT Clinic of Ataturk Training and Research Hospital, using the chi-squared test, Fisher's exact test, t-test and multiple logistic regression statistical analysis.
The effects of prognostic factors and smoking on myringoplasty were investigated by variables noted from patients' files such as smoking status, operation type, duration of dry period of the diseased ear, peroperative otorrhoea, status of the opposite ear, presence of perforation at admission, place of perforation, size of perforation, status of middle ear mucosa, presence of cholesteatoma and tympanosclerosis, ossicular status, previous and related surgery, experience of the surgeon, presence of anterior overhang, presence of valsalva manoeuvre, postoperative antiobiotic cover and income per day.
The overall take rate of the myringoplasty graft was 71%. Based on the univariate analysis, smoking status of the patients (P = 0.008), status of the opposite ear (P = 0.01), size of perforation (P = 0.009) and the experience of the surgeon (P = 0.002) were found to be statistically significant (P < 0.01) prognostic factors influencing the success rate of the operations. Multiple logistic regression analysis was subsequently carried out on these prognostic factors and yielded the following classification (95% CI): senior surgeon (OR = 14.3), non-smoking patient (OR = 11.4), longer duration of dry period of the diseased ear (OR = 5.3), normal opposite ear (OR = 5.0) and small perforation (OR = 4.8).
A non-smoking patient, a longer dry ear, a healthy opposite ear, a relatively smaller perforation and a senior surgeon were found to be significant prognostic factors positively influencing the success rate of myringoplasty.
本研究旨在评估吸烟及其他预后因素对鼓膜成形术长期手术效果及听力结果的影响。
回顾性队列研究。
三级医疗中心。
对阿塔图尔克培训与研究医院第一耳鼻喉科门诊2000年1月至2002年11月期间74例接受鼓膜成形术患者病历中的80例鼓膜成形术进行回顾性分析，采用卡方检验、费舍尔精确检验、t检验及多元逻辑回归统计分析。
通过患者病历记录的变量，如吸烟状况、手术类型、患耳干燥期时长、手术中是否有耳漏、对侧耳状况、入院时穿孔情况、穿孔部位、穿孔大小、中耳黏膜状况、是否存在胆脂瘤和鼓室硬化、听骨链状况、既往及相关手术、外科医生经验、是否存在前悬、是否存在瓦尔萨尔瓦动作、术后抗生素覆盖情况及每日收入等，研究预后因素及吸烟对鼓膜成形术的影响。
鼓膜成形术移植物的总体成活率为71%。基于单因素分析，发现患者的吸烟状况（P = 0.008）、对侧耳状况（P = 0.01）、穿孔大小（P = 0.009）及外科医生经验（P = 0.002）是影响手术成功率的具有统计学意义（P < 0.01）的预后因素。随后对这些预后因素进行多元逻辑回归分析，得出以下分类（95%置信区间）：资深外科医生（比值比[OR]=14.3）、非吸烟患者（OR = 11.4）、患耳干燥期较长（OR = 5.3）、对侧耳正常（OR = 5.0）及穿孔较小（OR = 4.8）。
发现非吸烟患者、患耳干燥期较长、对侧耳健康、穿孔相对较小及资深外科医生是对鼓膜成形术成功率有积极影响的重要预后因素。
