保留部分骨桥的鼓室显微成形术治疗胆脂瘤型中耳炎的临床效果  

Clinical efficacy of micro-tympanoplastic operation with osteo retention on treating otitismedis

作　　者：于锋[1] 龚辉成[1] 张浩亮[1] 谭国杰[1] 黄羽张[1] 

机构地区：[1]广州市第十二人民医院耳鼻咽喉科,广州510630

出　　处：《中华显微外科杂志》2010年第4期290-292,共3页Chinese Journal of Microsurgery

摘　　要：目的探讨保留部分骨桥的鼓室显微成形术在治疗胆脂瘤型中耳炎临床效果、影响预后的因素及综合治疗的地位。方法选择33例43耳胆脂瘤型中耳炎行保留部分骨桥的鼓室成形术．并对手术方法、技术要点、术后出现问题和疗效进行分析。结果随访18－72个月，术后3～4个月以后采用内镜显像系统或手术显微镜观察，可见43耳乳突及鼓窦区为上皮覆盖，乳突腔上皮化良好．中耳与乳突腔分隔良好，移植鼓膜愈合39耳（39／43，90．7％），2耳分别在术后4个月、6个月因感染发生穿孔，经抗炎治疗及烧灼治疗后痊愈，1耳上鼓室鼓窦处肉芽组织生长，有少量脓液，经抗炎换药处理后15周干耳，1耳术腔反复流脓，经抗炎及物理治疗，24周后干耳。术后听力检测结果显示语言频率气导术后平均值较术前提高（16．8±6．8）dSHL，听力改善为：79．1％（34／43）。结论选择适当的手术适应证，围术期的综合治疗，手术中病灶清理彻底，保留部分骨桥的鼓室一期成形术在治疗胆脂瘤型中耳炎临床效果良好。Objective To discuss with micro-tympanoplastic operation with osteo retention on treating cholesteatomatous otitismedis. Methods Choose 33 cases cholesteatomatous otitis medis patients who toke the tympanoplastic with osteo retention operation,then analyze the postulate and method of the operation, curative effect and complication after operation. Results Follow up with those patients by 12-72 months, and when 3-4 months after operation we endoscopiced the ears, could see that 43 cases of patients ear mastoid process and tympanic sinus were covered with epithelium, those mastoid cavity were well epithelial metaplasia; and the middle ear was separate from mastoid cavity;39 cases patient of transplant eardrums are heal up （39/ 43, 90.7%）. 2 cases have perforation of the tympanic membrane toke place after 4 months and 6 months with the operation, and it will heal up by anti-inflammatory drug and laser burning, 1 case had tympanic sinus hyper- plasia with granulation tissue, and also had grassery juice; after taken anti-inflammatory drug and change bandage for 15 weeks, the symptom disappear. 1 case had grassery juice of operation cavity, after taking anti-in- flammatory drug and physiotherapy, the symptom disappear in 24 weeks. After operation the pure tone audiometry shows that air conduction raise （16.8±6.8） dB HL, hearing raise up to：79.1%（34/43）. Conclusion Base on fight indication of operation choose, taken combined therapy of ambi-operation period, focus of infection are thoroughly cleaning up. Tympanoplastic with osteo retention are treating well with patients of cholesteatomatous otitismedis.

关 键 词：胆脂瘤 鼓室成形术 保留骨桥 中耳炎 耳显微手术 

分 类 号：R764[医药卫生—耳鼻咽喉科]