开放式乳突根治术并Ⅲa型鼓室成形术治疗胆脂瘤中耳炎的临床研究

摘要

Objective:To explore the curative effect and auditory outcomes in canal wall -down mastoidectomy and type Ⅲa tympanoplasty. Methods; Retrospective review of 62 patients with cholesteatoma , who underwent canal wall-down mastoidectomy and type Ⅲa tympanoplasty with titanium partial ossicular replacement prosthesis in a single stage. The postoperative complication , operation and aural rehabilitation were analyzed during 2-4 years follow-up. Results: In all 62 cases, 3 patients remained tympanic perforation , 6 patients with postoperative retraction pocket, 1 reurrence of cholesteatoma and 3 (3/62, 4.8%) extrusion of ossicular replacement prosthesis. The rate of total curative effectiveness was 58. 1% , dry ear was 91. 9% , postoperative infection rate was 8. 1%. Auditory outcomes showed that preoperative average air threshold (500, 1k, 2k, 4 k Hz) was (51. 0 ±13. 5) dB, postoperative (32. 6 ±8. 8 ) dB, and average air threshold reduction was statistically significant (t =16. 549, P <0. 01). Preoperative average air-bone gap was (35.2 ±10.0) dB, postoperative was (24.4 ±7.7) dB, with statistical significance (t = 11.276, P <0. 01). Conclusion: Canal wall-down mastoidectomy and type Ⅲa tympanoplasty with titanium partial ossicular replacement prosthesis in single stage is safe and effective surgery for chol -esteatoma, with less complication and relatively satisfactory hearing improvement . Application of tragal cartilage -perichondria autograft is of unique advantages .%目的:探讨开放式乳突根治术并Ⅲa型鼓室成形术治疗胆脂瘤中耳炎的临床效果.方法:62例胆脂瘤中耳炎患者均行开放式乳突根治术并Ⅲa型鼓室成形术(钛质部分听骨植入),随访2～4年,观察手术、术后并发症及听力恢复情况.结果:62例中3例鼓膜遗留穿孔,6例鼓膜内陷,1例胆脂瘤复发,3例(3/62,4.8%)听骨赝复物脱出,手术总有效率为58.1%,术后干耳率达91.9%,术后感染率为8.1%.术前气导平均听阈(500,1 k,2 k,4 k Hz)为(51.0±13.5)dB,术后为(32.6±8.8)dB,平均听阈降低具有统计学意义(t=16.549,P＜0.01).术前平均气骨导差为(35.2±10.0)dB,术后为(24.4±7.7)dB,平均气骨导差缩小具有统计学意义(t=11.276,P＜0.01).结论:开放式乳突根治术并Ⅲa型鼓室成形术(钛质部分听骨植入)是胆脂瘤中耳炎安全有效的术式,手术并发症少,听力提高效果较满意,术中应用耳屏软骨-软骨膜修复鼓膜具有独特的优点.