【作者】 付勇； 汪审清； 古庆家； 柴亮； 周水洪； 凌玲；

【机构】 浙江大学医学院附属第一医院耳鼻咽喉科；

【摘要】 目的:对儿童胆脂瘤型中耳炎常用的两种手术方法进行评估。方法:对临床资料完整的1990年1月～2005年2月收治的儿童胆脂瘤型中耳炎进行回顾性分析。行完壁式乳突切开(ICW)伴鼓室成形术者为ICW组,行开放式乳突切开(CWD)伴鼓室成形术者为CWD组。对两种术式的优缺点、听力改善程度及复发情况进行对比。同时按听骨链重建类型分组:部分听骨赝物(PORP)组和全听骨赝物(TORP)组,对两组的听力改善程度结果进行对比。结果:ICW组共18耳,CWD组共34耳;ICW组手术后0.5、1、2 KHz纯音听力(PTA)气导听阈较术前改善14dBHL,术后平均气、骨导差(ABG)较术前缩小12.8dBHL;CWD组术后PTA气导听阈较术前改善12.4dBHL,术后平均气、骨导差(ABG)较术前缩小11.3dBHL。两组术后听力改善程度无统计学差异。ICW组手术复发率22.2%(4/18)明显高于CWD组术后术复发率9.68%(3/31)。听骨链重建类型对术后听力的影响无统计学差异。结论:严格掌握手术适应证及彻底清除病灶是手术成功的关键。两种手术方法各有优缺点,术式的选择主要依靠患儿的病变程度及范围、解剖特点、手术医生的技术以及患儿自身的客观情况,应该通过对每一个患儿的具体情况进行合理的判断来选择手术方式。为了提高手术效果,减少并发症,我们建议进行分期手术。更多还原

【Abstract】 Objective:The outcomes of intact cannal wall (ICW)mastoidectomy with tympanoplasty and cannal wall down(CWD) mastoidectomy with tympanoplasty were assessed,as comparisons of different surgical technique.Methods:52 cases of pediatric cholesteatoma were analyzed retrospectively.Hearing results and recurrence rates were studied in pediatric patients after ICW and CWD mastoidectomy with tympanoplasty.Hearing results were studied in pediatric patients after ossicular reconstruction with partial ossicular replacement prostheses(PORPS) and total replacement prostheses(TORPS).Result:According to different surgical groups,the difference of hearing results was not statistically significant,but the recurrence rates of ICW group was evidently higher than CWD group.According to different ossicular reconstruction,the difference of hearing results was not statistically significant.Conclusion:The key is strictly masterring of the indications and quite eliminating of the focus ,the two methods had respectively several advantages anddisadvantages.The surgery should be tailored for each case ,which was based on the seasoned judgment from surgeons.In order to enhance the effects and decrease the complications,we recommend staging.更多还原