330例乳突再手术相关因素分析  

Causes of Revision Mastoidectomy in 330 Cases

作　　者：李盼盼 王乐[1] 叶放蕾[1] LI Panpan;WANG Le;YE Fanglei(Department of Otology,First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China)

机构地区：[1]郑州大学第一附属医院郑东院区耳科

出　　处：《中华耳科学杂志》2020年第1期103-107,共5页Chinese Journal of Otology

摘　　要：目的对慢性化脓性中耳炎和中耳胆脂瘤乳突再手术的相关因素进行分析。方法回顾性分析330例(338耳)乳突再手术的临床资料。记录再手术前患者的影像学检查、是否合并慢性鼻-鼻窦炎、术中所见、病菌培养结果、术后病理结果及听力变化情况等。结果乳突轮廓化不全256耳;外耳道口狭窄247耳;面神经嵴高169耳;乙状窦前移105耳;中颅窝脑板低垂97耳;面神经走行异常8耳;咽鼓管鼓室口病变118耳;慢性鼻-鼻窦炎91耳;术后未定期换药18耳;二期听力重建8耳;术后面瘫3耳。病菌培养结果:真菌感染82耳,细菌感染74耳,真菌合并细菌感染12耳;术后病理:慢性炎症183耳,胆脂瘤140耳,肿瘤6耳。再手术行听力重建的125例患者术后平均气导听阈及平均气骨导差均较术前显著下降(P<0.001)。结论乳突再手术常见原因有术后不干耳、二期听力重建、术后面瘫,预防术后不干耳可以有效降低再次手术发生率。Objective To report causes of revision mastoid surgeries in chronic suppurative otitis media(CSOM and middle ear cholesteatoma.Methods Clinical data of 330 patients(338 ears)who had undergone revision mastoidectomy were reviewed,including preoperative imaging,history of chronic rhinosinusitis,intraoperative findings,microbiologic culture results,pathology reports,changes in pure tone audiometry,etc.Results Potential causes of revision included incomplete mastoid skeletonization(256 eras),external auditory canal stenosis(247 ears),high facial ridge(169 ears),anteriorly displaced sigmoid sinus(105 ears),low-lying middle cranial fossa(97 ears),aberrant facial nerve courses(8 ears),lesions at eustachian tube opening(118 ears),chronic rhinosinusitis(91 ears),irregular postoperative dressing changes(18 ears),secondary hearing reconstruction(8 ears)and postoperative facial nerve palsy(FNP,3 ears).Fungal infection was confirmed in 82 ears,bacterial infection in 74 ears,and mixed fungal and bacterial infection in 12 ears.Chronic inflammation was seen in 183 ears,cholesteatoma in 140 ears and tumor in 6 ears.In patients who received hearing reconstruction,mean postoperative air conduction-pure tone audiometry(AC-PTA)thresholds significantly improved with significantly reduced air-bone gap(ABG)(P<0.001).Conclusion The common reasons for revision mastoidectomy are continued draining ear after surgery,needs for secondary ossicular chain reconstruction and postoperative FNP.Improving the rate of dry ear after mastoidectomy can lower the rate of revision mastoidectomy.

关 键 词：中耳炎 胆脂瘤 耳外科手术 再手术 不干耳 

分 类 号：R764[医药卫生—耳鼻咽喉科]