摘要
目的探讨胆脂瘤性中耳炎的外科治疗方法。方法本文介绍了2009年11月-2010年7月在我院接受乳突鼓室成形伴上鼓室切开重建（Mastoidotympanoplasty with epitympanoplasty,EMT）手术的56例（耳）,即在保留外耳道后壁切开乳突的前提下,同时进行上鼓室外侧壁的切除以彻底清除病灶,最后进行上鼓室乳突填塞并重建听力。本文初步报告了这一技术并对与此相关的外科处理策略进行临床评价。结果全部病例术后随访时间1~9个月,1例术后疼痛再次手术,2例术后感染鼓膜穿孔未愈合,2例术后鼓膜紧张部后上微小穿孔,其余病例术后愈合良好,术后换药2~3次即完全愈合,术后随访56例中26例听力资料完整,0.5、1、2kHz气骨导间距由术前平均31.9dB HL缩短到19.6dB HL。结论保留外耳道后壁乳突切开同时切除术上鼓室外侧壁并进行重建,简化了经典完壁式手术的复杂操作,易于掌握;同时,手术保留的外耳道后壁使耳道形态得以保留,术后恢复时间短,减少了术后换药次数;上鼓室软骨填塞可有效的防止回缩袋的形成,避免了胆脂瘤的复发。该术式为治疗中耳炎性疾病提供了一种新的选择。
Objective To discuss the surgical technique in the treatment of cholesteatomatous otitis media. Methods Fifty six ears underwent mastoidotympanoplasty with epitympanoplasty in our hospital from November 2009 to July 2010. This technique include mastoidectomy with canal wall up, epitympanoplasty with cartilage obliteration and hearing reconstruction. This paper report and discuss the related technique. Results All cases were followed up 1-9 months. One cases had to received revision operation because of ear pain 3 months after the first operation. Two cases had the residual perforation of tympanic membrane because of healing worse and another two cases had perforation again after operation in the posterosuperior ear dream. The rest cases healed well within one months. 26 cases of 56 had the whole hearing document with the average AB gap of 0.5, 1, 2 kHz shorting from 31.9 dBHL to 19.6 dB HL. Conclusion The mastoidectomy with canal wall up accompanied by epitympanoplasty with cartilage obliteration simplified the classical technique of CAT. The healing time was shortened greatly because of the preserved canal wall. The cartilage obliteration in the attic can prevent the forming of the abstraction pocket effectively and the recurrence of cholesteatoma. This technique provides another selection of treating otitis media for otologist.
出处
《中华耳科学杂志》
CSCD
2010年第3期254-257,共4页
Chinese Journal of Otology
