全耳内镜下经外耳道上鼓室胆脂瘤手术分析

发布时间：2018-06-08 17:20

本文选题：耳内镜手术 + 上鼓室　；参考：《中华耳科学杂志》2017年04期

【摘要】：目的探讨全耳内镜下经外耳道处理上鼓室胆脂瘤的手术方法、术后效果以及临床应用特点。方法回顾性分析我科自2016年1月至2017年1月收治的中耳上鼓室胆脂瘤并行全耳内镜下手术的患者。选取符合标准的病例总数47例,男28例,女19例;年龄15~68岁,平均41岁。术中常规取耳屏软骨-软骨膜复合物修补鼓膜、重建上鼓室,于耳内镜下清除胆脂瘤,行鼓室成形术,根据具体情况行上鼓室重建术、听骨链重建术。分别于术后1月、2月、3月和6月复查。结果所有47例患者中,32例(68%)为局限在上鼓室的胆脂瘤,15例(32%)为胆脂瘤同时累及中鼓室、前鼓室;其中21例(45%)听骨链完整,26例(55%)锤骨/砧骨有破坏。其中29例行听骨链重建术。所有患者术后均无面瘫、耳流脓、鼓膜穿孔。术后复查,所有患者的鼓膜形态良好,无内陷、无穿孔,移植物形态良好。术前平均气导听阈为43.45±9.56 d B HL,术后平均气导听阈为27.23±6.89 d B HL,术前术后比较具有统计学差异(P0.01)。术前平均气骨导差为28.42±6.78 d B HL,术后平均气骨导差为13.62±8.67d B HL,术前术后比较具有统计学差异(P0.01)。其中29例行听骨链重建术者,术后气骨导差10d B HL者11例,10~20d B HL者13例,20~30d B HL者3例,30d B HL者2例。所有患者均未出现病变复发、病变残余,无二次手术者。结论全耳内镜经外耳道手术处理上鼓室胆脂瘤是一种安全有效的手术方法。
[Abstract]:Objective to investigate the surgical treatment of cholesteatoma of the upper tympanic chamber by endoscope. Methods from January 2016 to January 2017, the patients with middle ear tympanum cholesteatoma treated with endoscope were retrospectively analyzed. A total of 47 cases, 28 males and 19 females, aged 1568 years, with an average age of 41 years, were selected. The tympanic membrane was repaired with perichondrium cartilage and perichondrium complex. Cholesteatoma was removed under endoscope and tympanoplasty was performed. The reconstruction of tympanotympanum and ossicular chain were performed according to the specific conditions. The reexamination was performed at 1 month, 2 months, 3 months and 6 months after operation, respectively. Results among the 47 patients, 32 cases were cholesteatoma confined to the upper tympanic chamber (15 cases). The cholesteatoma involved the middle tympanic chamber and anterior tympanum at the same time, and 21 cases (45%) were involved in the middle tympanic chamber and anterior tympanic chamber. In 26 cases, the ossicular chain was intact and 55%) the hammerbone / incus was damaged. 29 of them underwent ossicular chain reconstruction. All patients had no facial palsy, ear pus and perforation of tympanic membrane. After operation, the tympanic membrane was in good shape, no invagination, no perforation and good graft morphology. The mean air conduction hearing threshold was 43.45 卤9.56 d / L before operation and 27.23 卤6.89 d / L after operation. The mean air-bone conductance difference was 28.42 卤6.78 days B HL2 before operation and 13.62 卤8.67 d B HL2 after operation. There was a significant difference between preoperative and postoperative differences (P 0.01). Twenty-nine cases underwent reconstruction of ossicular chain, 11 cases with 10d BHL and 13 cases with BHL with 10d / 20d BHL, 3 cases with 30 d B-HL and 2 cases with 30 d BHL. No recurrence, residual lesions and no secondary surgery were found in all patients. Conclusion Total ear endoscopy is a safe and effective method for the treatment of upper tympanic cholesteatoma.
【作者单位】：陕西省人民医院耳鼻咽喉头颈外科;
【基金】：西安市科技计划项目(GG06190)~~
【分类号】：R764.9

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