摘要
目的：研究慢性中耳炎行鼓室成形术的患者高位颈静脉球（HJB）的发生率及HJB裸露并发术中破裂出血的处理。方法：对2005年1月～2006年8月287例慢性中耳炎行鼓室成形术的患者进行回顾性研究，结合高分辨率CT（HRCT）所见及术中处理加以分析。结果：287例慢性中耳炎患者中，HRCT检查发现HJB65例，左侧14例，右侧31例，双侧20例。术中发现颈静脉球顶部骨壁缺损5例，其中1例发生颈静脉球出血，占0．35％（1／287）。以胶原蛋白海绵片封闭静脉裂口，再以合适大小颞肌肌瓣填压后出血控制效果好。发生颈静脉球出血者经止血后，顺利完成了清除病灶、听骨链重建等全部手术步骤。结论：鼓室成形术术前需注意颈静脉球情况，手术中遇到HJB，尤其在颈静脉球与下鼓室间骨壁缺损时易发生颈静脉破裂出血时，颞肌肌瓣及胶原蛋白海绵片是较好的止血材料，同时短暂控制性低血压及术中冷静、及时、恰当的处理也是减少出血、保证安全的重要措施，并可继续完成既定手术。
Objective：To study the incidence of high jugular bulb （HJB） in the patients with chronic otitis media and to explore the management of its active bleeding during middle ear surgery. Method： From January 2005 to August 2006, consecutive 287 patients undergoing surgical intervention for chronic otitis media were retrospectively studied. The high resolution CT （HRCT） scan and the surgical technique for diagnosis and management of bleeding of jugular bulb were also discussed. Result：Sixty-five patients （22.6 %） were diagnosed as HJB by H RCT scan, including 21 men and 44 women （ P 〈0.01）, with their ages ranged from 7 to 68 years （mean 41 years）. Fourteen cases of them were on the left side, and 31 were on the right side （ P 〈0.05）. Twenty cases showed bilateral HJB. Five cases were found dehiscent high jugular bulb by CT scan and were confirmed in operation. Active bleeding was encountered in one case while elevating the pathological eardrum in hypotympanum. It was treated by pressure compression using collagen gelfoam cushion covered by muscle to protect the dehiscent bulb. The patients proceed through the planned surgery without complications. Conclusion： HJB might cause hemorrhea during middle ear surgery, but preliminary attention, correct treatment and awareness of the pitfalls may lessen the operation risk.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2007年第4期157-159,共3页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
中耳炎
鼓室成形术
高位颈静脉球
出血
手术
Otitis media
Tympanoplasty
High jugular bulb
Blood loss,surgical
