【摘要】 目的研究慢性中耳炎快速愈合并避免遗留乳突术腔的外科技术——"四合一手术",即一期病变根除、乳突术腔填塞、鼓室成形和外耳道创面植皮全复盖手术。方法对73例(75耳)慢性中耳炎(肉芽型35耳,胆脂瘤型40耳)行"四合一手术"治疗。其中同时39耳单纯行鼓膜修补术,36耳行Ⅲ型鼓室成形术(鼓膜修补+镫骨加高术)。结果术后愈合干耳率达96%(72/75),修补鼓膜穿孔闭合率为94.4%(68/72),听骨重建成功率为97.2%(35/36)。愈合时间平均18.6天。随访0.5～3.5年,未见明显充填物萎缩、遗留大术腔、流脓和胆脂瘤复发者。术后1～3个月语频纯音测听显示胆脂瘤组和肉芽组气导听力分别平均提高16.6dB和17.3dB。两组气骨导差缩小至20dB以内者共60耳,听力改善率80%(60/75)。结论 "四合一手术"技术是治疗慢性中耳炎的安全、干耳愈合时间短、避免乳突大术腔问题并同时能改善听力的有效方法。更多还原

【Abstract】 Objective To introduce a "four-in-one" surgical procedure the combines disease removal with primary mastoid cavity obliteration,tympanoplasty and meatal skin grafting in treating chronic otitis media(COM) which help accelerate postoperative healing and avoid large mastoid cavities. Methods Seventy three patients with COM (75 ears) were treated with this new procedure. 35 ears with Pathologies included granulation tissue(n=35) and cholesteatoma(n=40). Disease eradication was combined with primary myringoplasty in 39 cases and with III type tympanoplasty 36 cases. Results Dry ear was achieved in 96% (72/75) of the treated ears, and tympanic membrane perforation closure in 94.4% (68/72) of the repaired ears. Ossicular chain reconstraction was successful in 35 of the 36 treated ears(97.2%). The average time lapse before dry ear was 18.6 days At 0.5 to 3.5 years follow up, no obvious filling tissue atrophy, large surgical cavity, or recurrence of infection or cholesteatoma was found. At 1 to 3 months post-operation, pure tone audiometric testing revealed that air conduction hearing improved by an average of 16.6 dB in e with cholesteatoma and 17.3 dB in those granulation group. The postoperative air-bone gap (ABG) was within 20 dB in 60 ears (80%) with significant perceived hearing improvement. Conclusion This "four-in-one" procedure is an effective approach in improving treatment outcomes and hearing in COM and helps avoid a large often problematic mastoid cavity.更多还原