胆脂瘤型中耳炎不同手术方法效果的分析  

Cholesteatoma:Effective Comparison of Different Tympanoplasty

作　　者：马新春[1] 石磊[1] 李建民[1] 张英[1] 肖英[1] 

机构地区：[1]青海大学附属医院耳鼻咽喉科,810001

出　　处：《青海医药杂志》2008年第12期1-3,共3页Qinghai Medical Journal

摘　　要：目的：对比分析同术者用不同手术方法治疗胆脂瘤型中耳炎的疗效。方法：47例（耳）为A组手术时间在2003年1月-2006年4月，男28例，女19例，年龄（13～83）岁，术后观察随访12个月～25个月，平均17．24个月。另38例为B组，手术时间在1995年4月-1999年12月，男21例，女17例，年龄（9～60）岁，术后观察随访6个月～9年，平均17．12个月，二组的年龄，术前气导（AC）和气骨导差（ABG）相似，统计分析差别无显著意义。治疗方法：A组包含上鼓室外壁重建（鼓室盾板修复），鼓索神经弹压听骨，防粘连可用吸收网片置入等多项综合技术。B组大多采用上鼓室，乳突外壁凿开和插柱法。二组都用最后一次随访听力为统计数据，统计分析用t检验。结果：术后AC，ABG和ABG术前后差值（dB），A组是27．05±12．53，12．89±8．08，22．34±11．92；B组是42．76±14．22，22．27±10．95，8．83±8．72，t检验P均〈0．01，差别都有显著意义，随访期A组有5耳发现鼓膜穿孔（10．6％），3耳接受再次手术，术中发现1耳有胆脂瘤上皮残留（2．1％）；再次术后听力恢复均满意，1耳随访1年以上，而B组有9耳因胆脂瘤复发被再次手术（22．5％）。结论：耳道骨回复作盾板等综合技术对提高胆脂瘤手术听力和减少复发有明显效果。Objective ：To compare the treatment effects of different tympanoplasty techniques on cholesteatoma. Methods： All patients with cholesteatoma were designed in the A group （28 males, 19 females, age, 13 to 83 years） to received the combination of many methods of operation （including lateral attic wall reconstruction ,chorda tympani nerve lightening prosthesis） between Jan 2003 and Apr 2006 with 12 -25 months of follow up, and the group B （21 males, 17 females ; age, 9 - 60 years） to received tympanoplasty with modified mastoidectomy between Apr 1995 and Dec 1999 with 6 months to 9 years of follow up. There was a age - , air conduction（AC） - and air bon gap（ABG） -matched before operation in two groups, t test was statistically done. Results： There was no difference between two groups in AC and ABG before operation but a significant difference was existed （ P 〈 0. 01 ） after operation. During the follow - up in group A, perforation occurred in 5 cases （ 10.6% ） again, 3 cases received a revision operation and one ear had cholesteatoma remnant （2.1% ） ; in group B, however , there were 9 cases （22.5%） to received revision operation because of recurrent Cholesteatoma. Conclusions：That tympanoplasry associates with other available ear operation can improve the hearing outcome and decrease recurrent in patients with cholesteatoma.

关 键 词：胆脂瘤 鼓室成型 手术效果 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]