重建上鼓室外侧壁的保留骨桥乳突切开鼓室成形术

发布时间：2018-06-23 21:27

  本文选题：慢性化脓性中耳炎 + 中耳胆脂瘤　； 参考：《中华耳科学杂志》2016年05期

【摘要】：目的探讨完桥式乳突切开鼓室成形术(intact-bridge tympanomastoidectomy,IBM)并用自体骨片重建上鼓室外侧壁的临床疗效。方法对48例(50耳)慢性化脓性中耳炎和中耳胆脂瘤患者采用IBM术式,清除病变后自体外耳道后壁骨片重建上鼓室外侧壁及听力重建,观察鼓膜愈合情况及听力提高水平,总结手术技术要点和术后疗效。结果术后随访3-21个月,干耳时间3-14周,平均6.7周;鼓膜穿孔愈合率92%(46/50耳),3耳因术后感染及1耳胆脂瘤上皮残留导致鼓膜穿孔不愈,经再次手术愈合。患耳的气导平均纯音听力(pure tone average,PTA)由术前53.7±6.9 d BHL提高到术后36.3±9.1d BHL,气骨导差(air-bone gap,ABG)由术前26.4±7.3 d BHL缩小到术后15.0±4.2d BHL,手术听力提高成功率(术后PTA-ABG≤20d BHL)为72%(36/50耳)。结论 IBM术式保留的"骨桥"对重建上鼓室外侧壁的骨片和鼓膜移植物起到支撑作用,结合上鼓室外侧壁重建保持了中上鼓室含气腔和正常外耳道后壁形态结构,减少术后鼓膜内陷袋形成,是中耳乳突手术的理想选择。
[Abstract]:Objective to investigate the clinical effect of intact-bridge tympanomastoid tympanoplasty and autogenous bone graft in reconstruction of lateral wall of the tympanic wall. Methods 48 cases (50 ears) of chronic suppurative otitis media and cholesteatoma of middle ear were treated with IBM operation. After removing the lesion, the lateral wall and hearing of the tympanic wall were reconstructed by autogenous external auditory meatus, and the healing of tympanic membrane and the improvement of hearing were observed. To summarize the technical points of operation and the effect of operation. Results the follow-up period was 3-21 months, dry ear time was 3-14 weeks (mean 6.7 weeks), the healing rate of tympanic membrane perforation was 92% (46 / 50 ears) due to postoperative infection and residual epithelium of 1 ear cholesteatoma. The mean pure tone hearing (pure tone) of the affected ears increased from 53.7 卤6.9 d before operation to 36.3 卤9.1 d after operation, and the air-bone gap decreased from 26.4 卤7.3 d before operation to 15.0 卤4.2 d after operation. The successful rate of hearing improvement (PTA-ABG 鈮，

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