鼓室硬化镫骨固定的手术方法探讨  

Investigation on the surgical method for tympanosclerosis with stapes fixation

作　　者：罗五根[1] 王栋 金雪玲[1] 廖辉煌 熊园平[1] 钟伟[1] 张剑[1] LUO Wugen;WANG Dong;JIN Xueling;LIAO Huihuang;XIONG Yuanping;ZHONG Wei;ZHANG Jian(Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Nanchang University,Nanchang,Jiangxi,330006,China)

机构地区：[1]南昌大学第一附属医院耳鼻咽喉头颈外科,江西南昌330006

出　　处：《中国耳鼻咽喉头颈外科》2021年第9期538-541,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：江西省重点研发计划项目(20161BBG70175)。

摘　　要：目的探讨镫骨固定的鼓室硬化患者的手术治疗方法。方法 2016年2月~2018年2月在南昌大学第一附属医院耳鼻咽喉头颈外科住院并完成镫骨手术的45例(45耳)镫骨固定的鼓室硬化患者,根据情况分别采用镫骨撼动术、镫骨底板钻孔活塞术和镫骨切除术3种手术方法治疗,分别比较手术前及手术后3个月、术后2年4个频率(500、1000、2000、4000 Hz)的平均气骨导差。结果 45例患者中,行镫骨撼动术30耳,镫骨底板钻孔活塞术11耳,镫骨切除术4耳,术后3个月手术成功率分别为56.7%、72.7%及50%,术后2年手术成功率分别为16.7%、72.7%及50%。结论对镫骨固定的鼓室硬化患者,应分期手术,对保留锤骨柄或保留锤骨和砧骨的患者,二期手术应选择镫骨底板钻孔活塞术,对没有保留锤骨柄的患者,二期手术应选择行镫骨切除和全人工钛听骨植入术,镫骨撼动术远期效果差,应尽量少采用。OBJECTIVE To discuss the surgical method for tympanosclerosis patients with stapes footplate fixation.METHODS A total of 45 patients(45 ears)diagnosed as tympanosclerosis with stapes footplate fixation underwent stapes surgery in our department from February 2016 to February 2018.Stapes mobilization,trepanation of stapes footplate with Piston or stapedectomy were performed based on the actual situation.The mean air-bone gap(ABG) of 4 frequencies(0.5,1,2,4 kHz) were compared at three points:before operation,2 months after operation and 2 year after operation.RESULTS Stapes mobilization(30 ears),stapedotomy with Piston(11 ears) and stapedectomy(4 ears) were performed for 45 ears with stapes footplate fixation.The postoperative success rates of stapes mobilization,stapedotomy with Piston and stapedectomy were 56.7%,72.7%,50% respectively at 3 months after operation,and 16.7%,72.7%,50% respectively at 2 years follow-up.CONCLUSION Staged operations should be performed if the stapes footplate were fixed.For the patients with reserved manubrium of malleus or malleus and incus,stapedotomy with Piston should be selected for the second stage operation.For the patients without reserved manubrium of malleus,total stapes resection and total artificial titanium ossicle implantation should be selected for the second stage surgery.The long-term effect of stapes mobilization is poor and shouldn’t be used as first choice.

关 键 词：中耳 耳硬化病 镫骨 鼓室成形术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]