咽鼓管钛镍支架置入治疗和预防中耳粘连四例  

Use of NiTi shape memory alloys in the eustachian tube to prevent and treat adhesive middle ear

作　　者：陈文文[1] 邓亚新[1] 童军[1] 乔艺[1] 钟笑[1] 祖轶鹤 

机构地区：[1]上海市第四人民医院耳鼻咽喉科,200081

出　　处：《中华耳鼻咽喉科杂志》2002年第1期55-57,T005,共4页Chinese Journal of Otorhinolaryngology

基　　金：上海市科技发展基金项目 (编号 :41190 6 6 )

摘　　要：目的　为探讨咽鼓管软骨段钛镍合金支架置入治疗和预防粘连性中耳炎的可行性并报告初步结果。方法　 1999年 2月～ 2 0 0 1年 2月对 2例 (侧 )粘连性中耳炎和 2例 (侧 )顽固性分泌性中耳炎作了咽鼓管软骨段钛镍合金支架 (国产材料自制 )置入。设计制作了安装器。为此 ,事先对 3组(5 6例粘连性中耳炎 ,2 7例分泌性中耳炎 ,5 2例无耳疾的鼻病患者 )作了咽鼓管咽口检查 ;2例尸头作了咽鼓管解剖。结果　咽口形态被分类为宽敞、狭小、缝隙 3种类型。粘连性中耳炎组分别是 2 0、31、5例 ;分泌性中耳炎组分别是 9、13、5例 ;鼻病对照组 45、7、0例。 3组比较 ,粘连性中耳炎组和分泌性中耳炎组与对照组比较差异有极显著性意义 (χ2 分别是 2 9 6 6、2 5 44 ,P值均 <0 0 0 1)。粘连型中耳炎组与分泌性中耳炎组比较则差异无显著性 (χ2 =1 5 9,P >0 0 5 )。尸头咽鼓管解剖 :软骨段长度有30mm ,呈梯形 ,底宽 11mm ,顶宽 4mm ,软骨覆盖薄薄的软骨膜和黏膜 ,呈现光滑表面 ,折叠后 ,中部可以承受 3～ 4mm宽的张开。支架置入后 ,2例粘连性中耳炎患者都取得了 (瓦氏法 )通畅 ,鼓室充气良好 ,听力增进 (语言频率气骨导差分别比术前缩小 15和 30dB)。 2例顽固性分泌性中耳炎中 1位鼓室充气 ,气骨导差闭合 ,随访Objective To explore and assess the use of NiTi shape memory alloys in the eustachian tube to prevent and treat adhesive middle ear. Methods All preliminary study cases were divided into three groups (A: 56 cases of adhesive otitis media, B: 27 cases of otitis media with effusion, C: 52 cases without ear disease as control). The eustachian orifice in all cases was observed by endoscopy. Autopsy of Eustachian tube was done in two specimens. The NiTi shape memory alloys were then installed into the Eustachian tube to prevent and treat adhesive middle ear in 4 cases. The installer of NiTi shape memory alloys was designed by ourselves. Results The Eustachian orifice can be classified into three types: wide, narrow and fissured. They comprised of 20,31 and 5 cases in group A, 9,13 and 5 cases in group B and 45,7 and 0 cases in group C, respectively. The differences among three groups were statistically significant (A, B vs C, χ 2 = 29.66, 25.44 respectively, P<0.001), but the difference between A and B was not statistically significant(χ 2=1.59, P>0.05). Two cases with adhesive otitis media gained good ventilation with Valsalva method and the audiometric improvement of 15-30 dB after the NiTi shape memory alloys installation. One of the two cases with otitis media with effusion gained A-B gap closure over 8 months, and the other still improved with ventilative tube removed. In all 4 cases, there was no any side-effect or signs of patulous Eustachian tube. Conclusion Adhesive otitis media can be prevented and treated by using NiTi shape memory alloys without any side-effect, but more study is necessary.

关 键 词：中耳炎 咽鼓管 中耳通气 钛镍记忆合金支架 中耳粘连 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]