改良完壁式乳突根治——鼓室成形术  

Intact Canal Wall Mastroidectomy with Sandwich Myringoplasty in Chronic Otitis Media

作　　者：于锋 刘文林 

机构地区：[1]广州市耳鼻咽喉头颈外科医院,广州510620

出　　处：《中华耳科学杂志》2012年第1期35-39,共5页Chinese Journal of Otology

基　　金：广东省科技计划项目(2010B031600015)

摘　　要：目的慢性中耳炎是常见的多发病,但治疗上还存在一些问题,本研究采用完壁式乳突根治-鼓膜夹层法修复鼓室成形术,探讨治疗慢性化脓性中耳炎临床疗效。方法选择慢性化脓性中耳炎85例(耳),行完壁式乳突根治-鼓膜夹层法修复鼓室成形术,对手术方法和临床疗效进行分析。SPSS14.0统计软件统计,采用校正的chi-squaretest检验。结果 85例(耳)总有效70例(82.4%,70/85),术前骨导听阈提高与病程长短、胆脂瘤无关(P>0.05),与听骨链中断、固定有相关性(P<0.05),听骨链的破坏吸收、肉芽包绕、固定会造成术前骨导听阈提高,该术式带蒂的"袖状"外耳道、鼓膜上皮瓣覆盖移植膜,具有良好的固位作用,较好地保留了鼓膜自然形态,听阈达到或保持在应用水平63例(74.1%,63/85)。鼓膜一期愈合率为96.47%(82/85)。结论手术适应证的正确选择的基础上,彻底清除病变是手术成功的关键所在,完壁式乳突根治-鼓膜夹层法修复鼓室成形术,最大限度地保留或还原了患者正常的中耳及外耳道的正常生理结构,提高了听力功能。Objective To report the utility of intact canal wall mastoidectomy with sandwich myringoplasty in treating chronic otitis media--a frequently occurring disease with often disputed treatment approaches. Method Operation techniques and treatment outcomes in 85 cases of chronic otitis media that underwent intact canal wall mastoidectomy with sandwich myringoplasty were reviewed. Data were analyzed using the SPSS1 4.0 software running adjusted chi-square assay. Results Hearing improvement was seen in 70 cases （82.4% ）, which was not correlated with preoperative bone conduction threshold elevation or duration of disease or existence of cholesteatoma, but rather with status of the ossicular chain （discontinuation or fixation, P0.05） Ossicular chain destruction, presence of granulation tissue, or fixation were associated with elevated bone conduction threshold before operation. The sandwich myringoplasty technique with pedicel ＂ sleeve＂ skin flap from the auditory canal and ear drum helped ensure fixation of the graft and ideal positioning of repaired ear drum, leading to achievement of useful postoperative hearing in 63 cases （74.1% ） and a 96.47 % （ 82/85 ） rate of primary ear drum healing. Conclusion Besides appropriate case selection , the key to successful treatment is complete disease eradication. The intact canal wall mastoidectomy with sandwich myringoplasty technique provides maximum preservation of natural structures of the middle and outer ear, leading to improved hearing outcomes.

关 键 词：夹层法 鼓膜成形术 中耳炎 胆脂瘤 耳显微手术 

分 类 号：R764.29[医药卫生—耳鼻咽喉科]