开放式乳突根治术后不干耳原因分析  

Cause analysis of non dry ear after canal wall down mastoidectomy

作　　者：高芬琦 王林娥 龚树生[1] 王振晓 梁文琦 GAO Fenqi;WANG Lin＇e;GONG Shusheng;WANG Zhenxiao;LIANG Wenqi(Department of Otolaryngology, Beijing Friendship Hospital, Capital Medical University, Bei- jing, 100050, China)

机构地区：[1]首都医科大学北京友谊医院耳鼻咽喉科,北京100050

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第7期530-533,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨开放式乳突根治术后不干耳的可能原因。方法:回顾性分析42例行开放式乳突再根治手术患者的临床资料,包括病史、症状、体征、听力学检查、影像学检查、术中发现、术后随访;全部患者均在全身麻醉下行开放式乳突再根治+鼓室成形术。结果:术中见窦脑膜角开放不彻底26例,乳突腔气房残留36例(乳突尖气房残留9例),天盖病灶残留8例,上鼓室前隐窝开放不全13例,后鼓室开放不全23例,面神经嵴过高25例,面后气房及迷路气房残留5例,圆窗处肉芽3例,咽鼓管功能不良5例,外耳道口狭窄32例。42例患者于开放式乳突再根治术后3个月、半年、1年随访均获得干耳。结论:窦脑膜角、乳突气房开放不彻底,上鼓室前隐窝开放不全,后鼓室内病变清理不彻底,面神经嵴过高,外耳道口狭窄均是开放式乳突根治术后不干耳的可能原因;面后气房及迷路气房由于位置隐蔽难以清除干净,术后换药未及时清理术腔也是导致术后不干耳的潜在原因。Objective：To investigate the possible causes of non dry ear after canal wall down mastoidectomy（CWD）.Method：Clinical data of 42 patients undergoing revision CWD in our hospital were analyzed retrospectively,which included history,symptoms,signs,audiological examination,imaging examination,intraoperative findings and postoperative follow-up.All patients underwent CWD and tympanoplasty under general anesthesia.Result：Twenty-six cases were insufficient opened of sinodural angle,36 cases remained mastoid air cell（9 cases is mastoid tip air cell remained）,13 cases were inadequate exposured of anterior epitympanic recess,23 cases were inadequate exposured of posterior tympanum,25 cases had high facial ridge,posterior facial nerve and labyrinth air cell were5 cases,3 cases had granulation in round window,5 cases had dysfunctional eustachian tube,32 cases had narrow external acoustic meatus.During 3 months,6 months and 1 year follow-up,all 42 cases patients under revision CWD presented with dry ears.Conclusion：Insufficient opened of sinodural angle and mastoid air cell,inadequate exposured of anterior epitympanic recess and posterior tympanum,high facial ridge,narrow external acoustic meatus are all the possible causes of no-dry ear after CWD;As the location of concealment,posterior facial nerve and labyrinth air cell are difficult to clean.The dressing cavity don＇t be cleaned in time after operation is also the underlying cause of postoperative non-dry ear.

关 键 词：开放式乳突根式术 鼓室成形术 干耳 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]