54例分期鼓室成形术的随访分析

发布时间：2018-05-23 14:24

本文选题：中耳炎 + 化脓性　；参考：《临床耳鼻咽喉头颈外科杂志》2017年16期

【摘要】：目的:通过对计划行分期鼓室成形术的54例慢性化脓性中耳炎患者的术中情况以及实际完成二期听骨链重建术的19例患者的术后听力疗效进行分析,为慢性化脓性中耳炎分期手术方式的选择提供参考。方法:因慢性化脓性中耳炎拟行分期鼓室成形术的患者54例(54耳),均已完成一期手术,鼓室均植入硅胶片预防粘连。已有19例完成二期听骨链重建术,其中10例植入完全人工听骨TORP,9例植入部分人工听骨PORP。听力水平以500、1 000、2 000和4 000Hz的平均气骨导差(ABG)计算。结果:54例患者中,45例鼓室及咽鼓管口黏膜肿胀,18例鼓室纤维粘连,12例镫骨底板固定或被硬化灶包埋。54例患者一期手术前平均ABG为(38.26±7.88)dB。已完成二期手术的19例患者,一期手术前平均ABG为(39.21±7.05)dB,二期手术前平均ABG为(38.82±11.43)dB,二期手术后为(21.77±11.92)dB。患者二期手术术后听力较一期及二期手术术前听力均有显著性提高(P0.01)。此外,另3例患者一期手术后半年平均ABG为(10.42±10.63)dB,因听力尚可,故推迟行二期手术。随访至今,54例患者均未出现面瘫、感染等中耳手术并发症。结论:慢性化脓性中耳炎手术中有不适宜一期听骨链重建者可采用分期治疗,以达到较好的听力康复效果、减少并发症的发生。
[Abstract]:Objective: to analyze the postoperative hearing effect of 54 patients with chronic suppurative otitis media scheduled for tympanoplasty and 19 patients with secondary ossicular chain reconstruction. To provide a reference for chronic suppurative otitis media stage operation. Methods: 54 cases (54 ears) with chronic suppurative otitis media were treated with tympanoplasty. The secondary ossicular chain reconstruction had been completed in 19 cases, of which 10 cases were implanted with complete artificial ossicular ossicles, 9 cases with partial ossicular PORP implantation. The hearing level was calculated by the average air-bone conductance difference (ABG) of 500 ~ 1 000 ~ 2 000 and 4 000Hz. Results of 54 cases, 45 cases were tympanic and eustachian tube mucosal swelling and 18 cases were tympanic fibrous adhesions, 12 cases were stapes floor fixation or sclerosing. The mean ABG was 38.26 卤7.88 dB before primary operation in 54 cases. The mean ABG was 39.21 卤7.05 dB before primary operation, 38.82 卤11.43 dB before secondary operation, 21.77 卤11.92 dB after secondary operation. The hearing of the patients after secondary operation was significantly higher than that before operation (P 0.01). In addition, the average ABG of the other 3 patients was 10.42 卤10.63 dB half a year after primary operation. All the 54 cases were followed up without facial palsy, infection and other complications of middle ear surgery. Conclusion: patients with chronic suppurative otitis media who have unsuitable primary ossicular chain reconstruction can be treated by stages in order to achieve better hearing rehabilitation effect and reduce complications.
【作者单位】：第四军医大学西京医院耳鼻喉科;
【分类号】：R764.9

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