文档介绍：开放式乳突根治术加Ⅲa型鼓室成形术治疗中耳炎疗效探讨
作者:冯立人,王孟东,顾建森,孙宝宾
【摘要】目的:探讨鼓室成形术治疗慢性化脓性中耳炎及胆脂瘤中耳炎的方法及疗效,尤其是如何形成有效振动、传导声音的含气中耳腔。方法:对61例(63耳)慢性化脓性中耳炎或胆脂瘤中耳炎患者施行开放式乳突根治术加Ⅲa型鼓室成形术,术中用乳突骨皮质及肌骨膜瓣填塞部分乳突腔。其中,A组(20耳)不修复上鼓室外侧壁及外耳道后上壁,直接将修复鼓膜的筋膜贴附于面神经嵴上;B组(24耳)填塞上鼓室,重建外耳道后上壁内段之后修复鼓膜;C组(19耳)不填塞上鼓室,重建外耳道后上壁内段、用软骨片修复上鼓室外侧壁之后修复鼓膜。结果:随访时间2年,%(57/63),A、B、C 3组间干耳率无显著性差异(P>)。术后A、B、C 3组气骨导缩减值分别为(±) dB、(±) dB及(±) dB,A组气骨导缩减值明显低于B组和C组(均P<),B组和C组无明显差异(P>)。结论:慢性化脓性中耳炎及胆脂瘤中耳炎施行开放式乳突根治术加Ⅲa型鼓室成形术可彻底清除病灶,获得较为满意的听力重建。正确选择手术适应证、形成位置恰当的外耳道后壁及鼓膜-镫骨的可靠连接,是获得良好疗效的关键。
【关键词】慢性化脓性中耳炎; 胆脂瘤中耳炎; 鼓室成形术; 乳突根治术
[Abstract] Objective: To investigate the methods and curative effects of mastoidectomy and tympanoplasty in the treatment of chronic suppurative otitis media and cholesteatoma otitis media. Methods: Open mastoidectomy plus type Ⅲa tympanoplasty was performed in 61 patients(63 ears) with chronic suppurative otitis media or cholesteatoma otitis mastoid cavities were tamped with mastoidal cortical bone and muscleperiosteum flap partly. There were three groups. Group A(20 ears): the temporal fasias were placed on facial ridge directly to repair the tympanic membranes without reconstruction of the posteriorsuperior bonewall of auricular meatus and outer wall of the attic cell. Group B(24 ears): the tympanic membranes were repaired with the attic cell plugging an