慢性中耳炎手术中多种技术综合运用的临床研究

发布时间：2019-04-24 18:09

【摘要】：目的探讨慢性中耳炎手术中,运用多种技术清除病灶,重建中耳传音结构,提高听力,防止复发。方法选取2009年1月——2010年6月期间,合肥市第一人民医院耳鼻咽喉科收住的慢性中耳炎患者50例(50耳)。所有患者均采用耳内Y型切口,使用气钻、铣钻、摆锯及耳显微手术器械等,在清除患者病灶的基础上,根据患者病变情况,运用自体外耳道-乳突骨皮质重建上鼓室外侧壁,外耳道壁及听骨链,术中使用鼓索神经弹压技术,固定自体听骨,使用外耳道-乳突骨膜以夹层法修补鼓膜,术后定期随访,并复查纯音听力测试,采用自身对照的方法,对比术前术后气骨导差之间的差异。结果50耳中通过术前、术后纯音听力测试检查听力级较术前提高10～30db的患耳有44例,手术成功率为88%。50耳言语频段术前术后平均气骨导差为17.67±14.63dBHL,经过配对t检验,p0.01,具有统计学意义,提示患者术后听力明显改善。在术后长期随访观察中,有45耳(90%)具有正常的外耳道、含气的中耳腔、形态正常的鼓膜。此45耳中,术后气骨导差18耳(40%)10dB,22耳(49%)20dB,5耳(11%)20dB,此5耳中3耳听力曲线较术前提高10～30dB。结论在慢性中耳炎手术中,通过多种技术的综合运用,可以在彻底清除病灶的基础上,重建听力结构,外耳道壁及上鼓室外侧壁,最大限度地保持中耳正常形态,改善听力,防止复发。
[Abstract]:Objective to study the effects of various techniques in the treatment of chronic otitis media, to reconstruct the structure of middle ear sound transmission, to improve hearing and to prevent recurrence of chronic otitis media. Methods from January 2009 to June 2010, 50 patients (50 ears) with chronic otitis media were enrolled in the department of otorhinolaryngology, first people's hospital of Hefei. All patients were treated with Y-shaped incision, air drill, milling drill, swing saw and ear microsurgical instruments, etc. On the basis of removing the lesions of the patients, the lateral wall of the upper tympanic chamber was reconstructed with the autogenous auditory meatus-mastoid cortex according to the pathological changes of the patients. The wall of external auditory meatus and ossicular chain were fixed by the technique of elastic compression of tympanic cord nerve, and the tympanic membrane was repaired by mezzanine technique of external auditory meatus-mastoid periosteum. The patients were followed up regularly after operation, and the pure tone hearing test was reexamined, and the method of self-control was used. The differences of air-bone conduction before and after operation were compared. Results among 50 ears, 44 ears with 10~30db improved by pure tone audiometry before and after operation, and the successful rate of operation was 88%. The mean air-bone conduction difference was 17.67 卤14.63 dBHLL before and after operation in the speech band of 50 ears, and the difference of air-bone conduction between pre-operation and post-operation was 17.67 卤14.63 dBHL in 50 ears. After paired t-test, p0.01 had statistical significance, suggesting that the patients' hearing was improved obviously after operation. During the long-term follow-up observation, 45 ears (90%) had normal external auditory meatus, air-bearing middle ear cavity and normal tympanic membrane. Of the 45 ears, 18 ears (40%) had postoperative air-bone conduction difference of 10 dB, 22 ears (49%) 20 dB, 5 ears (11%) 20 dB. Conclusion in the operation of chronic otitis media, the hearing structure, the wall of the external auditory canal and the lateral wall of the upper tympanic chamber can be reconstructed on the basis of the thorough removal of the lesion, and the normal shape of the middle ear can be maintained to the maximum extent, and the hearing can be improved through the comprehensive application of various techniques in the operation of chronic otitis media. Prevent recurrence.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764

【参考文献】