摘要
目的对开放式鼓室成形术中利用自体骨粉行上鼓室乳突腔填充的方法及疗效进行评价。方法接受手术治疗的胆脂瘤型中耳炎患者的43例(43耳)分为两组。实验组,行开放式鼓室成形术+自体皮质骨上鼓室乳突腔填充术+耳甲腔成形术23例(耳);对照组,行常规开放式鼓室成形术+耳甲腔成形术20例(耳)。术后随访6～36个月,观察两组患者术后听力结果、干耳率情况。结果以术后语言频率气骨导差缩小>15dB或气导听阈<40dB为有效标准,实验组(n=23)有效率69.56%(16/23),对照组(n=20)有效率65%(13/20),组间比较无统计学意义(x^2=0.1015 P>0.05)。实验组(n=23)干耳率为91.3%(21/23),明显高于对照组60%(12/20),表明统计学差异有统计学意义(x^2=4.2508 P<0.05)。实验组(n=23)术后平均干耳时间为30.65±8.43天,对照组(n=20)为37.75±10.83天,统计学差异有统计学意义(T=2.4136 P<0.05)。实验组外耳道口宽大,乳突腔容积缩小,表面上皮化良好,无肉芽组织生长,无感染及渗出,鼓膜形态良好。全部病例均无胆脂瘤复发。结论开放式鼓室成形术+自体皮质骨上鼓室乳突腔填充术+耳甲腔成形术,能有效清除中耳病灶组织、术后听力结果满意,换药时间短,干耳率高,是较为理想的手术方式。
Objective To evaluate the therapy of canal wall down tympanoplasty with mastoid and epitympanic obliteration using autologous cortical bone chips, bone pate. Methods Retrospective case review. All 43 patients were divided into 2 groups. The experimental group included 23 ears who underwent canal wall down tympanoplasty with mastoid and epitympanic obliteration using autologous cortical bone and conchaplasty. The control group was consisted of 20 ears who underwent regular canal wall down tympanoplasty with conchaplasty. Follow-up lasted for 6-35 months and postoperative hearing and dry ear rate were evaluated. Results Based on the criteria for success defined as AB gap closure over 15 dB HL or air conduction threshold less than 40 dB HL （using the mean of 0.5-, 1-, and 2-KHz threshoM values）. The effective rate was 69.56%（16/23）in the experimental group and 65%（13/20） in the control group. No significant difference was found between the two groups （x^2=0.1015 P〉0.05）. The dry ear rate of experimental group was significantly higher titan the control group（91.3% vs 60%） with statistic significance （x^2=4.2508 P〈0.05）. There was no difference between the 2 groups in terms of average drying ear time （30.65±8.43 days vs 37.75±10.83 days, respectively, t=2.4136 P〈0.05）. The experimental group had larger orifice of external auditory meatus and reduced mastoid cavity. The surface was well epithelialized without granulation or infection arid exudation. And the appearance of the tympanic membrane was satisfied. Conclusion The canal wall down tympanoplasty with mastoid and epitympanic obliteration using autologbus cortical bone and conchaplasty has advantage in complete removal of lesions and is more efficient in improving hearing and obtaining dry ear.
出处
《中国中西医结合耳鼻咽喉科杂志》
2013年第2期95-97,共3页
Chinese Journal of Otorhinolaryngology in Integrative Medicine
关键词
胆脂瘤
鼓室成形术
上鼓室乳突腔填充
自体皮质骨
Cholesteatoma
Tympanoplasty
Mastoid and epitympanic obliteration
Autologous cortical bone
