开放式乳突根治术加ⅲa型鼓室成形术治疗中耳炎疗效探讨

《开放式乳突根治术加ⅲa型鼓室成形术治疗中耳炎疗效探讨》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。

1、开放式乳突根治术加Ⅲa型鼓室成形术治疗中耳炎疗效探讨作者：冯立人，王孟东，顾建森，孙宝宾【摘要】目的:探讨鼓室成形术治疗慢性化脓性中耳炎及胆脂瘤中耳炎的方法及疗效,尤其是如何形成有效振动、传导声音的含气中耳腔。方法：对61例(63耳)慢性化脓性中耳炎或胆脂瘤中耳炎患者施行开放式乳突根治术加Ⅲa型鼓室成形术，术中用乳突骨皮质及肌骨膜瓣填塞部分乳突腔。其中，A组(20耳)不修复上鼓室外侧壁及外耳道后上壁，直接将修复鼓膜的筋膜贴附于面神经嵴上;B组(24耳)填塞上鼓室，重建外耳道后上壁内段之后修复鼓膜;C组(19耳)不填塞上鼓室，重建外耳道后上壁内段、用软骨片修复上

2、鼓室外侧壁之后修复鼓膜。结果：随访时间2年，总干耳率90.48%(57/63),A、B、C3组间干耳率无显著性差异(P>0.05)。术后A、B、C3组气骨导缩减值分别为(13.5±1.87)dB、(19.79±2.13)dB及(22.63±2.04)dB,A组气骨导缩减值明显低于B组和C组(均P<0.01),B组和C组无明显差异(P>0.05)。结论：慢性化脓性中耳炎及胆脂瘤中耳炎施行开放式乳突根治术加Ⅲa型鼓室成形术可彻底清除病灶，获得较为满意的听力重建。正确选择手术适应证、形成位置恰当的外耳道后壁及鼓膜-镫骨的可靠连接，是获得良好疗效的关

3、键。【关键词】慢性化脓性中耳炎;胆脂瘤中耳炎;鼓室成形术;9乳突根治术　　[Abstract]Objective:Toinvestigatethemethodsandcurativeeffectsofmastoidectomyandtympanoplastyinthetreatmentofchronicsuppurativeotitismediaandcholesteatomaotitismedia.Methods:OpenmastoidectomyplustypeⅢatympanoplastywasperformedin61patients(63ears)w

4、ithchronicsuppurativeotitismediaorcholesteatomaotitismedia.Allmastoidcavitiesweretampedwithmastoidalcorticalboneandmuscleperiosteumflappartly.Therewerethreegroups.GroupA(20ears):thetemporalfasiaswereplacedonfacialridgedirectlytorepairthetympanicmembraneswithoutreconstructionofthepo

5、steriorsuperiorbonewallofauricularmeatusandouterwalloftheatticcell.GroupB(24ears):thetympanicmembraneswererepairedwiththeatticcellpluggingandreconstructionoftheposteriorsuperiorbonewallofauricularmeatus.GroupC(19ears):thetympanicmembraneswererepairedwithreconstructionoftheposter

6、iorsuperiorbonewallofauricularmeatusandouterwalloftheatticcell.Results:Allcaseswerefollowedupfor2years.Totaldryingearratewas90.48%(57/63),therewasnosignificantdifferencamongthethreegroups(P>0.05).Theaveragevalue9ofenhancedhearingingroupA,BandCwere(13.5±1.87)dB,(19.79±2.13)dBand

7、(22.63±2.04)dBrespectively.TherewasnosignificantdifferencebetweengroupBandC(P>0.05),butbetweengroupAandB,groupAandCtherewassignificantdifference(P<0.01).Conclusion:OpenmastoidectomyplustypeⅢatympanoplastywoulderadicatediseasesandobtaingoodhearinginthetreatmentofchronicsuppurat

8、iveotitismediaandch