听骨链重建术中锤骨的处理对鼓室硬化患者疗效的影响  

The impact of malleus processing in ossicular chain reconstruction on the therapeutic effect in patients with tympanosclerosis

作　　者：舒繁[1] 郭梦和[1] 谢南屏[1] 张宏征[1] 万良财[1] 

机构地区：[1]南方医科大学珠江医院耳鼻咽喉-头颈外科,广州510282

出　　处：《临床耳鼻咽喉头颈外科杂志》2013年第10期455-457,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨鼓室硬化患者行听骨链重建术中,锤骨的不同处理方式对术后疗效的影响,为术式的选择提供参考。方法:回顾分析59例(62耳)接受听骨链重建术的鼓室硬化病例的临床资料,按术中对锤骨的处理方式分为去除锤骨组(24耳)、仅保留锤骨柄组(18耳)和完整保留锤骨组(20耳)。分析3组患者术前、术后3个月、术后1年的纯音听阈测定言语频率平均气骨导差及气骨导差改善值,并用耳内镜观察鼓膜移植物存活情况,比较3种锤骨处理方式对疗效的影响。结果:去除锤骨组、仅保留锤骨柄组、完整保留锤骨组术前气骨导差分别为(40.07±7.56)、(37.31±6.45)、(36.75±6.72)dB,3组之间的差异无统计学意义;术后3个月3组病例平均气骨导差较术前分别缩小(18.15±8.64)、(17.69±6.65)、(18.17±8.39)dB,差异无统计学意义(P>0.05)。术后1年,气骨导差较术前分别缩小(17.92±9.28)、(16.76±5.19)、(10.58±7.38)dB,其中完整保留锤骨组与去除锤骨组和仅保留锤骨柄组比较,差异有统计学意义(P<0.05);而去除锤骨组与仅保留锤骨柄组比较,差异无统计学意义(P>0.05)。术后1年,去除锤骨组和仅保留锤骨柄组各1例鼓膜穿孔人工听骨脱落,其余鼓膜完整、无塌陷。结论:听骨链重建术中锤骨的不同处理方式对鼓室硬化患者短期疗效无显著影响;长期疗效方面,完整去除锤骨和仅保留锤骨柄效果相当,均显著优于完整保留锤骨。Objective：To investigate the effect of different malleus treatments on the postoperative efficacy in the tympanosclerosis patients receiving ossicular chain reconstruction.Method：Fifty-nine patients（62 ears） with tympanosclerosis were treated by ossicular chain reconstruction.All the patients were divided into three groups,including malleus removal group（A,24 ears）,retaining only the malleus handle group（B,18 ears） and the intact malleus group（C,20 ears）.All the patients were followed up 3 months pre-operation,3 months and 1 year post-operation by audiometric measurement（the average hearing threshold at 0.5,1.0,2.0 kHz HL）.Tympanic membrane was examined by ear endoscope.Result：The pre-operation mean air bone gap（ABG） in these groups were 40.07±77.56 dB,37.31±76.45 dB,and 36.75±76.72 dB,among which the difference had no statistical significance（P〉0.05）.At 3 months after operation,the ABG in all cases was improved at 0.5,1 and 2 kHz.The difference of ABG improvement among these three groups had no statistical significance（P〈0.05）.One year after surgery,the ABG of the three goups were decreased by 17.92±9.28 dB,16.76±5.19 dB and 10.58±7.38 dB respectively.The hearing improvement in group C is less than the other two groups（P=0.03,P=0.016）.The difference of hearing improvement between group A and group B had no statistical significance（P〉0.05）.Group A and group B each have one case of tympanic membrane perforation and artificial ossicle falling off.Conclusion：The operating processes of malleus in ossicular chain reconstruction of patients with tympanosclerosis were introduced.In terms of short-term efficacy,the three groups showed no signfficant difference.However,the long-term efficacy of the patients in the group A and group B were better compared with the group C.

关 键 词：鼓室硬化 听骨链重建术 锤骨 疗效 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]