慢性化脓性中耳炎手术治疗的临床研究

发布时间：2018-03-29 14:54

本文选题：慢性化脓性中耳炎　切入点：骨疡型　出处：《浙江大学》2011年硕士论文

【摘要】：目的探讨慢性化脓性中耳炎的手术策略及术式选择,比较不同术式的临床特点。方法本文回顾性分析了本院耳鼻咽喉科2007年——2010年6月收治的248例慢性化脓性中耳炎病例(包括骨疡型及胆脂瘤型)中73例(73耳)至少随访6个月的经一期乳突鼓室成形术治疗的病例,比较切除外耳道后壁的乳突鼓室成形术(canal wall down:CWD)与保留外耳道后壁的乳突鼓室成形术(canal wall up:CWU)两种常用术式的临床特点。结果对各组病变侵犯的范围、手术数量、干耳时间、语言频率气导听阈与气骨导差缩小程度及慢性化脓性中耳(胆脂瘤型)的复发率进行比较：CWD组病变侵犯范围明显要广于CWU组,CWD组病变主要集中在乳突、鼓窦、上鼓室及后鼓室,而CWU组主要局限在乳突、鼓窦及上鼓室；CWD及CWU手术量逐渐增多,但CWU增多更加明显；CWU组干耳时间(6.2±2.4周)明显短于CWD组(9.2±3.0周)(F=20.57,P0.01)；CWU组语频区听力提高幅度及气骨导差缩小程度明显优于CWD组(F=6.32,P0.05；F=8.63,P0.01)；CWD组胆脂瘤型复发率为12.5%,而CWU组为16.7%,两者无统计学差异(X2=0.162,P0.05)。结论尽管目前慢性化脓性中耳炎的手术治疗仍以安全性为根本,但是随着耳科器械的进步及术者水平的提高,最大限度地保留或恢复听力功能也已经成为本病外科治疗的重要目标之一,故一味的进行开放式手术是不可取的,现推荐手术应以鼓窦—上鼓室探查结合CWU开始,根据术中所见决定乳突开放范围。
[Abstract]:Objective to explore the surgical strategy and choice of operation for chronic suppurative otitis media and to compare the clinical characteristics of different surgical methods. Methods A total of 248 cases of chronic suppurative otitis media (including bone type and cholesteatoma type) in our department of otolaryngology from 2007 to June 2010 were retrospectively analyzed. Tympanoplasty, To compare the clinical characteristics of mastoid tympanoplasty with resection of posterior wall of external auditory meatus and mastoid tympanoplasty with reserved posterior wall of external auditory meatus and mastoid tympanoplasty with preservation of posterior wall of external auditory meatus. Results the extent of lesion invasion, the number of operations, the dry ear time, A comparison was made between the speech frequency hearing threshold, the degree of narrowing of the air-bone conduction difference and the recurrence rate of chronic suppurative middle ear (cholesteatoma type). The extent of lesion invasion in the CWU group was significantly wider than that in the CWU group. The lesions were mainly concentrated in the mastoid process, tympanic sinus, superior tympanic chamber and posterior tympanic chamber. In CWU group, CWD and CWU were mainly localized in mastoid process, tympanic sinus and superior tympanic chamber. But the dry ear time of CWU group was significantly shorter than that of CWD group (9.2 卤3.0 weeks). The hearing improvement and the reduction of air-bone conductance difference were significantly better in CWU group than that in CWD group. The recurrence rate of cholesteatoma was 12.5in CWU group, and 16.7in CWU group. There was no significant difference between the two groups. Conclusion although the surgical treatment of chronic suppurative otitis media is still based on safety at present, with the progress of ear instruments and the improvement of the operative level, Preserving or restoring hearing function to the maximum extent has also become one of the important targets of surgical treatment of this disease, so it is not advisable to blindly carry out open operation. It is recommended that the operation should begin with the combination of tympanic sinus-subotympanic exploration and CWU. The open range of mastoid process was determined according to the intraoperative findings.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764

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