全耳内镜中耳手术恢复不良处理经验分享  

Experiences of poor recovery after total endoscopic middle ear surgery

作　　者：王健艳 常改华 张权照 陈愈彬[1] WANG Jianyan;CHANG Gaihua;ZHANG Quanzhao;CHEN Yubin(Department of Otorhinolaryngology Head and Neck Surgery,the Third Affiliated Hospital of Sun Yat-Sen University,Guangzhou,510630,China;Department of Otorhinolaryngology Head and Neck Surgery,Macao Kiang Wu Hospital,China)

机构地区：[1]中山大学附属第三医院耳鼻咽喉头颈外科,广州510630 [2]澳门镜湖医院耳鼻咽喉头颈外科,中国

出　　处：《临床耳鼻咽喉头颈外科杂志》2025年第1期77-83,共7页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨全耳内镜中耳手术后恢复不良发生情况及对策。方法:对2020年6月至2021年6月在中山大学附属第三医院耳鼻咽喉头颈外科行全耳内镜中耳手术302例(315耳)患者,术后1、3、6个月及1年分别进行疗效评估,了解鼓膜愈合不良、听力恢复不良等情况的发生率、可能原因、处理对策及效果。结果:随访恢复不良患者共28例。鼓膜愈合不良14例,门诊耳内镜鼓膜贴补治疗后10例愈合,成功率约71.4%。中耳胆脂瘤或粘连性中耳炎术后鼓膜再发内陷粘连4例,自行咽鼓管吹张后1例内陷袋完全恢复,2例患者维持鼓膜内陷程度未再进展,1例无效者选择再次手术治疗,有效率为75.0%。听力下降无改善或加重8例,均进行二次手术探查,7例二次手术后听力改善,有效率为87.5%;8例术后存在听力下降无改善或加重的患者中:有4例术后一直为C型或B型鼓室图,经咽鼓管吹张后听力不能提高进行二次手术探查,二次手术后听力改善;2例听骨方位调整后听力改善;1例鼓膜外移者,手术将鼓膜内移后听力改善;1例鼓室硬化进行二次手术但仍再发硬化,听力改善不佳。术后外耳道再发瘢痕闭锁1例,患者不愿再次手术。术后迟发性面瘫1例,予以药物保守治疗后面瘫恢复。结论:鼓膜贴补及咽鼓管吹张是简易而有效的早期门诊处理方法。对于部分预后不良的患者,及时的二次手术探查是安全、有效的。全耳内镜下中耳手术后规律复查有利于及时发现并处理恢复不良的病例。Objective:To investigate the occurrence and managements of poor recovery after total endoscopic middle ear surgery.Methods:A total of 302 cases(315 ears)who underwent endoscopic middle ear surgery in our hospital from June 2020 to June 2021 were collected.Follow up by means of endoscopy,pure tone hearing threshold,tympanogram was conducted at 1 month,3 months,6 months and 1 year after surgery to analyze the incidence,possible causes,treatment strategies and effects of poor results tympanic membrane healing and hearing recovery.Results:Among 302 patients(315 ears)followed up,there were 28 cases with poor recovery.There were fourteen cases of poor eardrum healing,of which 10 cases achieved healing of eardrum after tympanic membrane patching in the outpatient department,with a success rate of about 71.4%.TM recurrence adhesion occurred in 4 cases after surgeries of cholesteatoma and adhesive otitis media.One case completely recovered after self eustachian tube insufflation,while 2 cases maintained the degree of eardrum subsidence,and one ineffective patient chose resurgical treatment,with an effective rate was 75.0%.Failure in hearing improvement occurred in 8 cases,all of which underwent second surgical exploration,and seven cases were improved after the second surgery,with an effective rate of 87.5%.Among the 8 patients with no improvement or aggravation of hearing loss after surgery,four cases had postoperative B-type or C-type of tympanogram,and the hearing could not improve after self eustachian tube insufflation for secondary surgical exploration.and the hearing improved after the secondary surgery.Incorrect orientation of ossicular prosthesis was accounted for another 2 cases,the hearing was improved after the ossicular orientation adjustment.One patient with lateral healing of TM and failed hearing recovery was corrected by a second operation.One case of tympanosclerosis underwent stapes release surgery,but hearing recovery still failed.One patient had recurrent postoperative cicatricial atresia of external

关 键 词：耳内镜中耳手术 恢复不良 术后处理 

分 类 号：R764.2[医药卫生—耳鼻咽喉科]