【摘要】 目的观察胆脂瘤手术保留正常耳道和听骨链并辅以围手术期中耳通气机通气的听力效果。方法回顾分析2002年10月到2010年4月间由资深术者所进行的41例采用"多种技术"完壁式并保留完整听骨链的胆脂瘤手术。充气组:术后采用充气治疗者,共12例,其中男3例,女9例;年龄28～75岁,中位年龄42岁;术前气骨导差(GAP)为(32.42±14.68)dBHL。对照组:以往手术采用同样技术但没有充气者,共29例,其中男15例,女14例;年龄15～65岁,中位年龄42岁;术前GAP为(26.79±11.84)dBHL。二组术前GAP的对照统计分析U检验值为1.185<P0.05=1.96,P>0.05。治疗前二组GAP差别没有显著性意义,表明二组具有可比性。充气组中耳充气每天1～2次,连续2周。所有充气治疗组和对照组病例术后都随访12个月以上。结果充气组术后GAP为(8.58±11.3)dBHL,与术前(32.42±14.68)dBHL相比较,经U检验,U值为4.46>P0.01=2.58,P<0.01,差异有极显著性意义。同样,对照组术后GAP为(13.21±9.64)dBHL,与术前(26.79±11.84)dBHL相比较,经U检验,U值为4.74>P0.01=2.58,P<0.01,差异也有极显著性差异。充气组和对照组的两组术后听力对比U检验,U值为-1.17<P0.05=1.96,P>0.05,两组术后GAP差别没有显著性意义。但是,充气组12例术后GAP全部缩小到<20dB以内,6例(50%)在<10dB以内;而对照组则有4例(14%)没有缩小到<20dB以内。结论对术中保留听骨链患者给予围手术期充气治疗,术后能获得更好的听力效果。更多还原

【Abstract】 Objective To study effects of ventilation on hearing outcomes after matoidectomy with intact canal wall and ossicular chain for cholesteatoma.Methods Forty-one cases performed by the senior author between October 2002 and April 2010 were reviewed.Peri-operative ventilation treatment was provided in 12 cases(Group A:3 males and 9 females,aged 28-75 years with a medium of 42 years).The mean pre-operative air-bone gap in this group was 32.42±14.68 dB,No ventilation was performed in the rest 29 cases(Group B,15 males and 14 females,aged 15-65 years with a medium of 42 years.The mean pre-operative air-bone gap was 26.79 ± 11.84 dB for this group.The pre-operation air-bone gap was not statistically different between the two groups(U test).In Group A,the mastoid was ventilated through a 2 mm silastic tube placed into the mastoid cavity once daily for 2 weeks postoperatively.All cases were followed up for at least 12 months.Results Mean air-bone GAP improved from 32.42 ± 14.68 dB to 8.58 ± 11.3 dB after surgery in Group A(U = 4.46,P < 0.01),and from 26.79 ± 11.84 dB to 13.21 ± 9.64 dB in Group B(U = 4.74,P < 0.01),The difference in post-operative hearing outcomes between Groups A and B was not statistically significant(U =-1.17,P > 0.05).However,the post-operative air bone GAP was 20 dB or less in all Group A cases,whereas the GAP was over 20 dB in 4 cases(14%) in Group B,indicating a trend toward better hearing outcomes with ventilation treatment.Conclusion In patients receiving mastoidectomy for cholesteatoma with preservation of the ossicular chain,peri-operative ventilation may be associated with better hearing outcomes.更多还原