顽固性分泌性中耳炎及相关后遗症的手术治疗效果分析  

Outcomes and Complications of Surgery for Refractory Otitis Media with Effusion

作　　者：刘利敏 高震 贾贤浩 袁雅生 LIU Limin;GAO Zhen;JIA Xianhao;YUAN Yasheng(Department of Otology and Skull Base Surgery,Eye Ear Nose and Throat Hospital,Fudan University,Shanghai 200031;National Key Laboratory of Hearing Science,Shanghai 200031;Department of Otolaryngology,General Hospital of Pingdingshan Pingmei Shenma Medical Group,Henan Province,Henan 467000)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳神经颅底外科,上海200031 [2]国家听觉医学重点实验室,上海200031 [3]河南省平顶山市平煤神马医疗集团总医院耳鼻咽喉科,河南467000

出　　处：《中华耳科学杂志》2020年第3期438-442,共5页Chinese Journal of Otology

基　　金：上海市卫生系统优秀带头人项目(2017BR057)。

摘　　要：目的探讨顽固性分泌性中耳炎(otitis media with effusion,OME)及相关后遗症的手术治疗策略及疗效。方法回顾分析复旦大学附属眼耳鼻喉科医院2014年7月-2017年12月期间收治的顽固性OME患者29例(31耳),31耳均接受了完壁式乳突切除,其中15耳同期行鼓膜置管术;6耳应用人工听骨行听骨链重建;5耳对鼓膜进行了修复。结果28耳获痊愈;3耳在术后6-12月时出现复发,改为开放式乳突切除+鼓膜置管术,均治愈。术后(包括再次手术)6个月复查纯音测听,语言频率(0.5-2KHz)气导平均值12-50dB[(33.06±10.82)dB],气骨导差在5-21 dB[(11.00±4.13)dB]之间。鼓室导抗图恢复为A型曲线者29耳,C型曲线2耳,但负压均在150 mm H20(1mm H20=0.0098 kPa)内。术后随访8个月-4年,31耳均无复发。结论经过各种方法治疗无效的慢性OME应考虑到有长期OME导致的不可逆并发症的可能性,积极采取中耳乳突手术治疗。Objective To report strategies and therapeutic outcomes of surgical treatments for refractory otitis media with effusion and related complications.Methods Twenty nine cases(31 ears)collected from July 2014 to Dec 2017 in the E.ENT Hospital,Fudan University,were retrospectively analyzed.All ears underwent intact canal wall mastoidectomy,of which,15 also received ventilation tube insertion,6 received ossicular chains reconstruction and 5 underwent myringoplasty.Results Recovery was successful in 28 ears and recurrence occurred in 3 ears in 6-12 months after surgery,which were revisited with radical mastoidectomy and myringoplasty with insertion of ventilation tubes.Average air conduction pure tone threshold over 0.5,1 and 2 kHz at 6 months after surgery(including revision)was 33.06±10.82 dB HL(range 12-50 dB HL)with an average air-bone gap of 11.00±4.13(range 5-21 dB).Tympanogram was type A in 29 ears and type C(negative pressure less than 150 mm H20)in 2 ears.There was no recurrence at 8 months to 4 years follow-ups.Conclusion When facing chronic secretory otitis media that has failed multiple treatment attempts,the physician should be concerned of the possibility of irreversible complications and relatively aggressive tympanomastoid surgical treatments should be considered.

关 键 词：分泌性中耳炎 积液 完壁式乳突切除 开放式乳突切除 

分 类 号：R764[医药卫生—耳鼻咽喉科]