摘要
目的:探讨开放式乳突根治术并Ⅲa型鼓室成形术治疗胆脂瘤中耳炎的临床效果。方法:62例胆脂瘤中耳炎患者均行开放式乳突根治术并Ⅲa型鼓室成形术(钛质部分听骨植入),随访2～4年,观察手术、术后并发症及听力恢复情况。结果:62例中3例鼓膜遗留穿孔,6例鼓膜内陷,1例胆脂瘤复发,3例(3/62,4.8%)听骨赝复物脱出,手术总有效率为58.1%,术后干耳率达91.9%,术后感染率为8.1%。术前气导平均听阈(500,1 k,2 k,4 kHz)为(51.0±13.5)dB,术后为(32.6±8.8)dB,平均听阈降低具有统计学意义(t=16.549,P<0.01)。术前平均气骨导差为(35.2±10.0)dB,术后为(24.4±7.7)dB,平均气骨导差缩小具有统计学意义(t=11.276,P<0.01)。结论:开放式乳突根治术并Ⅲa型鼓室成形术(钛质部分听骨植入)是胆脂瘤中耳炎安全有效的术式,手术并发症少,听力提高效果较满意,术中应用耳屏软骨-软骨膜修复鼓膜具有独特的优点。
Objective： To explore the curative effect and auditory outcomes in canal wall-down mastoidectomy and type Ⅲa tympanoplasty. Methods： Retrospective review of 62 patients with cholesteatoma, who underwent ca- nal wall-down mastoideetomy and type IIIa tympanoplasty with titanium partial ossicular replacement prosthesis in a single stage. The postoperative complication, operation and aural rehabilitation were analyzed during 2-4 years fol- low-up. Results ： In all 62 cases, 3 patients remained tympanic perforation, 6 patients with postoperative retraction pocket, 1 reurrence of cholesteatoma and 3 （3/62, 4. 8% ） extrusion of ossieular replacement prosthesis. The rate of total curative effectiveness was 58.1% , dry ear was 91.9% , postoperative infection rate was 8. 1%. Audi- tory outcomes showed that preoperative average air threshold （500, 1 k, 2 k, 4 k Hz） was （51.0 -± 13.5） dB, postoperative （32.6 ±8.8 ） dB, and average air threshold reduction was statistically significant （t = 16. 549, P 〈0.01 ）. Preoperative average air-bone gap was （35.2 ± 10.0） dB, postoperative was （24.4 ±7.7 ） dB, with statistical significance （t = ll. 276, P 〈0. 01）. Conclusion： Canal wall-down mastoidectomy and type Ⅲa tym panoplasty with titanium partial ossicular replacement prosthesis in single stage is safe and effective surgery for chol- esteatoma, with less complication and relatively satisfactory hearing improvement. Application of tragal cartilage- perichondria autografl is of unique advantages.
出处
《新医学》
2013年第4期262-265,共4页
Journal of New Medicine
关键词
开放式乳突根治术
鼓室成形术
听力重建
胆脂瘤
中耳炎
Mastoidectomy, canal wall-down
Tympanoplasty
Auditory reconstruction
Cholesteatoma
Otitis media
