耳内镜下上鼓室胆脂瘤手术技巧及效果分析  

Transcanal Endoscopic Ear Surgery for Attic Cholesteatoma

作　　者：王涛[1] 瞿申红[1] 叶林松[1] 唐杰 谢志国 Wang Tao;Qu Shenhong;Ye Linsong;Tang Jie;Xie Zhiguo(Department of Otorhinolaryngology Head and Neck Surgery,Guangxi Zhuang Autonomous Region People's Hospital,Nanning,530021,China)

机构地区：[1]广西壮族自治区人民医院耳鼻咽喉头颈外科,南宁530021 [2]广西宁明县人民医院耳鼻咽喉科

出　　处：《听力学及言语疾病杂志》2019年第3期297-300,共4页Journal of Audiology and Speech Pathology

摘　　要：目的探讨经外耳道耳内镜下治疗上鼓室胆脂瘤的手术方法及术后效果。方法回顾性分析2015年11月至2018年2月收治的23例经外耳道耳内镜下手术的上鼓室胆脂瘤患者的临床资料,所有患者均在耳内镜下以电钻或骨凿去除盾板开放上鼓室,清除胆脂瘤,探查听骨链,根据听骨破坏情况选择听力重建方式行鼓室成形术,分别于术后1、2、3、6个月随访疗效。结果 23例患者中,15例(65.2%)听骨链完整,8例(34.8%)听骨链破坏者术中行人工听骨植入,其中2例镫骨底板上结构消失者行全听骨链植入(TORP),6例锤骨、砧骨或锤砧关节破坏者行部分听骨链植入(PORP),23例常规取耳屏软骨-软骨膜复合物行鼓膜成形术,其中21例取耳屏软骨重建上鼓室外侧壁。23例术前0.5～4 kHz平均气导听阈为51.2±8.5 dB HL,术后6月为25.2±6.8 dB,术后较术前明显下降,差异有统计学意义(P<0.01),术前0.5～4 kHz平均气骨导差为26.3±6.2 dB,术后6月为11.2±8.7 dB,术后均较术前明显缩小,差异有统计学意义(P<0.01)。结论经外耳道入路耳内镜下清除上鼓室胆脂瘤创伤小,视野清晰,术后听力提高明显,是安全有效的手术方式。Objective To study surgical techniques, outcomes and application characteristics of the transcanal endoscopic ear surgery for attic cholesteatoma. Methods Data from 23 patients who underwent transcanal endoscopic ear surgery for attic cholesteatoma in our department from November 2015 to February 2018 were retrospectively analyzed. Under the otoendoscope,using the electric drill or bone chisel remove the scutum and open the epitympanum,then remove the cholesteatoma, explore the ossicles, and perform the hearing reconstruction and the tympanoplasty in parallel.Reexamination was conducted 1, 2, 3 and 6 months after surgery. Results Of the 23 patients, ossicles were intact in 15 cases (65.2%) and 8 cases ( 34.8%)showed ossicular chain erosion. In 8 cases ( 34.8%), the ossicular chain were recohstructed by artificial ossicle implantation, including 2 cases where the superstructures of the stirrup bone base plates were disappeared, and TORP was implanted, and 6 cases where the malleus, incus or incudomalleolar joint were damaged and implanted in PORP. In 23 cases, the tragus cartilage-perichondrium composite was routinely harvested for tympanoplasty. In 21 cases, the external wall of the epitympanum was reconstructed with the cartilage of tragus.The mean preoperative air conduction threshold was 51.2 ± 8.5 dB HL which was significantly higher them 25.2 ± 6.8 dB HL postoperatively ( P <0.01). The mean preoperative air-bone gap was 26.3±6.2 dB, which was significantly higher them 11.2±8.7 dB postoperatively ( P <0.01). Conclusion The transcanal endoscopic ear surgery for attic cholesteatoma has advantages of minimal invasion and clear operational field.It is a safe and effective surgical method which is worthy of promotion.

关 键 词：上鼓室 胆脂瘤 耳内镜手术 鼓室成形术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]