中耳乳突再手术相关因素分析  

Analyses of the factors relevant to revision tympanomastoid surgery

作　　者：李莉[1] 樊兆民[1] 韩月臣[1] 徐磊[1] 陈东[1] 王海波[1] 

机构地区：[1]山东大学附属省立医院山东省立医院集团眼耳鼻喉医院耳鼻咽喉头颈外科山东省听力重建重点实验室山东省人工听觉工程技术中心,济南250021

出　　处：《中华耳鼻咽喉头颈外科杂志》2016年第5期333-337,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：基金项目：“十二五”国家科技支撑计划（2012BA112801）;山东省自然科学基金面上项目（ZR2010HM001）

摘　　要：目的 分析慢性中耳炎中耳乳突再手术的相关因素.方法 回顾性分析159例（159耳）因前次手术后出现术后不干耳或复发而再次行中耳乳突手术治疗的慢性中耳炎患者的临床资料,其中男85例,女74例,年龄11 ～64岁（中位年龄36岁）.记录并分析患者再次手术的术中所见、手术方式、术后换药情况、干耳时间及听力提高情况.结果 再手术时发现,159例再手术患者中有胆脂瘤者67例,无胆脂瘤者92例;前次手术乳突未充分轮廓化、气房开放不全者占70.4％（112/159）;外耳道口狭小者占98.7％ （157/159）;面神经嵴高、阻碍术腔自洁者占61.0％ （97/159）;咽鼓管鼓室口存在病变者占34.6％（55/159）;术后换药不规范致耳道后壁皮瓣前移,引起耳道狭窄,影响引流者占5.0％ （8/159）;前次手术耳后切口者占30.8％（49/159）例,耳内切口者占69.2％ （110/159）.再次中耳乳突手术,行开放式乳突切除＋鼓室成形及耳甲腔成形者94例,行改良Bondy＋耳甲腔成形者4例,行乳突根治＋耳甲腔成形者59例,单纯乳突清理者2例.再次手术后1～2周开始显微镜下术腔换药,平均1周换药1次,术后干耳时间为2～6周（中位时间为3周）.随访6 ～ 93个月,159例均干耳,术腔上皮化良好,行鼓室成形者鼓膜完整,未再发现肉芽形成或胆脂瘤复发.87例听骨链重建者,再次手术后的纯音听阈和气骨导差均较术前下降,差异具有统计学意义（P值均＜0.05）.结论 中耳乳突手术后不干耳或胆脂瘤复发的主要原因可能与手术方式及切口选择不当,手术操作不规范、病变清除不彻底,以及术后换药不规范等因素有关.Objective To analyze factors relevant to revisional tympanomastoid surgery for chronic otitis media（COM）.Methods The clinical data of 159 patients （159 ears）,who exhibited either wet ear or relapsed after the initial operation,and were subjected to revisional tympanomastoid surgery,were retrospectively analyzed in this study.Of those 159 consecutive patients,85 were males and 74 were females,aged 11-64 years,with a median age of 36 years old.The situations in terms of intra-operative findings,surgical procedures,change dressing post-operation,dry ear time,and the improvement of aural ability during the second operation,were recorded and analyzed.Results The second surgery found that,of those 159 patients underwent the re-operation,67 presented with cholesteatoma and 92 had no cholesteatoma.In addition,the inadequate skeletonization and insufficient opening for mastoid cavity accounted for 70.4% （112/159） of all previous operations,the external auditory canal stenosis for 98.7%（157/159）,the high facial ridge leading to insufficient drainage for 61.0% （97/159）,the lesion in tympanic ostium of Eustachian tube for 34.6% （55/159）,the insufficient drainage due to inappropriate post-operating dressing for 5.0% （8/159）,the postauricular incision for 30.8% （49/159）,and the endaural incision for 69.2% （110/159）.As for the re-operation of the canal wall down mastoidectomy,tympanoplasty plus plastic repairing of cavity of concha were performed in 94 cases,the modified Bondy plus plastic repairing of cavity of concha in four cases,the radical mastoidectomy plus plastic repairing of cavity of concha in 59 cases,and the simple cleaning for mastoid cavity in two cases.Since one to two weeks after the revisional operations,the post-operating dressing was performed with aid of microscopy once a week on average.The average dry ear time ranged from 2 to 6 weeks （median =3 weeks）.During a period of 6-93months for the follow-up,all patients presented with dry ears.The epithelialization of the op

关 键 词：中耳炎 胆脂瘤 中耳 耳外科手术 再手术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]