【摘要】 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 kHz)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。更多还原

【Abstract】 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(500,1 k,2 k,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 cholesteatoma,with less complication and relatively satisfactory hearing improvement.Application of tragal cartilage-perichondria autograft is of unique advantages.更多还原