慢性中耳炎并发迷路瘘管的诊治分析  

Diagnosis and treatment of labyrinthine fistula caused by chronic otitis media

作　　者：张威[1] 袁艺昕 孙鹏程[1] 陈婷[1] 班莫璐 刘友利[1] ZHANG Wei;YUAN Yixin;SUN Pengcheng;CHEN Ting;BAN Molu;LIU Youli(Department of Otolaryngology Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China)

机构地区：[1]南方医科大学南方医院耳鼻咽喉头颈外科,广州510515

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第13期1013-1015,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：2014广东省省级科技计划项目(No:2014A020212491)

摘　　要：目的:探讨慢性化脓性中耳炎并发迷路瘘管的临床特征、诊治经验及手术治疗方法。方法:回顾性分析2006-06-2013-06期间收治的24例(24耳)经手术证实的慢性中耳炎并发迷路瘘管患者的临床资料,术前进行瘘管试验及颞骨CT扫描,并比较两者诊断迷路瘘管的阳性率。所有患者均在全身麻醉下行乳突根治术,术中均一期对瘘口处的病变组织进行清理,Ⅰ型、Ⅱ型瘘管取颞肌筋膜或乳突骨膜覆盖封闭瘘口,Ⅲ型瘘管以筋膜行半规管阻塞术。比较瘘管分型对患者术前、术后听力的影响。结果:慢性中耳炎并发迷路瘘管的发生率为2.93%,术中发现23例瘘管位于水平半规管,1例位于后半规管。颞骨CT扫描阳性率为41.66%,瘘管试验阳性率为37.5%,2种方法对迷路瘘管的诊断阳性率差异无统计学意义(P=0.50)。瘘管分型对于患者术后听觉变化的影响差异无统计学意义(P=0.73)。结论:同时利用瘘管试验及CT扫描可能会提高迷路瘘管的诊断准确率,但试验结果阴性时并不可靠,术中探查所见是确诊迷路瘘管最重要的依据。应根据瘘管的分型、大小、患者听力以及术者的经验来决定手术方式。Objective：To evaluate the clinical features diagnostic experience and the surgical management of labyrinthine fistula in chronic suppurative otitis media.Method：Twenty-four cases（24 ears）of labyrinthine fistula caused by chronic suppurative otitis media that were treated from 2006 to 2013 were reviewed.The fistula test and temporal bone CT scan were performed before the operation,then compare the positive rates between them.In all of these cases,the lesion tissue of fistula is cleaned.Then the fistula was repair of through fascia sealing by temporal myofascial or mastoid periosteum in typeⅠ andⅡfistula.Semicircular canal occlusion was used in typeⅢfistula.Comparison of the effect of fistula typing on preoperative and postoperative hearing.Result：The fistulae were located at the lateral semicircular canal in 23 ears,at the lateral semicircular canal in 1 ears.temporal bones was positive in 10 cases（41.66%）while fistula test was positive in 9 cases（37.5%）.There was no statistically significant difference between the diagnosis of the labyrinthine fistula（P=0.50）.The effect of fistula typing on postoperative auditory changes was not statistically significant（P=0.73）.Conclusion：In the preoperative diagnosis of the fistula,the use of fistula test and CT scan simultaneously may increase the accuracy of the diagnostic.However the test results are not reliable when is negative results,intraoperative exploration is the most important method for the diagnosis of labyrinth fistula.Surgery should be based on the type of fistula,size,hearing levels and operation experience.

关 键 词：迷路瘘管 慢性中耳炎 诊断 手术 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]