上鼓室切开重建术与Bondy改良乳突根治术治疗Ⅰ期松弛部胆脂瘤的疗效比较
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摘要
目的:通过与Bondy改良乳突根治术比较,评估与分析上鼓室切开重建术治疗Ⅰ期松弛部胆脂瘤的手术疗效及安全性。方法:回顾性分析36例(36耳)Ⅰ期松弛部胆脂瘤患者的临床资料,随机分为上鼓室切开重建组(21例)和Bondy改良乳突根治组(15例)。观察2组患者手术前后的听力情况,术后2个月的干耳率、术腔上皮化时间,分析术后鼓膜内陷、胆脂瘤残留及复发、耳漏等并发症的情况。结果:2组患者术前、术后平均气骨导差(ABG)及ABG增益均无显著性差别,即上鼓室切开重建术与Bondy改良乳突根治术对Ⅰ期松弛部胆脂瘤患者术前听力保存与改善程度并无显著性差异(P>0.05)。但上鼓室切开重建组的手术用时短,且术后2个月的干耳率显著高于Bondy改良乳突根治组,术腔上皮化时间亦较Bondy改良乳突根治组明显缩短(P<0.05)。2组患者术后均未见胆脂瘤残留与复发。结论:对于局限于上鼓室及听骨链完整的Ⅰ期松弛部胆脂瘤,上鼓室切开重建术可有效地清除病变,避免开放手术术后遗留较大的术腔,保留外耳道正常解剖结构,具有听力保存良好、术后愈合快等优点,有较好的临床应用价值。
Objective: To compare the efficacy and safety between Bondy modified radical mastoidectomy(BMRM) and atticotomy for stage Ⅰ epitympanic cholesteatoma. Method: A retrospective analysis of 36 cases with stage Ⅰ epitympanic cholesteatoma was performed. According to different surgery methods, the cases were divided into the atticotomy group(21 cases) and the BMRM group(15 cases). Hearing function, the dry ear ratio after two months of the surgery, and the epithelial time were observed. The complications for the retraction of tympanic membrane, residual or recurrence of cholesteatoma, and otorrhea were analyzed. Result: There was no significant difference between the two groups in average air-bone gaps(ABG) and ABG gain before and after surgery(P>0.05). The preoperative hearing was preserved both in the atticotomy group and the BMRM group. However, more surgery time, lower ratio of the dry ear after two months of the surgery, and longer epithelial time were observed in the BMRM group than those in the atticotomy group(P<0.05). No cholesteatoma residual or recurrence was observed in both groups. Conclusion: For stage Ⅰ epitympanic cholesteatoma lateral to an intact ossicular chain, atticotomy has the advantage of complete removal of the cholesteatoma matrix, avoiding big mastoidal cavity, keeping normal anatomical structure of external auditory canal, better hearing preservation, and faster healing. Therefore, atticotomy has better clinical and practical value.
Objective: To compare the efficacy and safety between Bondy modified radical mastoidectomy(BMRM) and atticotomy for stage Ⅰ epitympanic cholesteatoma. Method: A retrospective analysis of 36 cases with stage Ⅰ epitympanic cholesteatoma was performed. According to different surgery methods, the cases were divided into the atticotomy group(21 cases) and the BMRM group(15 cases). Hearing function, the dry ear ratio after two months of the surgery, and the epithelial time were observed. The complications for the retraction of tympanic membrane, residual or recurrence of cholesteatoma, and otorrhea were analyzed. Result: There was no significant difference between the two groups in average air-bone gaps(ABG) and ABG gain before and after surgery(P>0.05). The preoperative hearing was preserved both in the atticotomy group and the BMRM group. However, more surgery time, lower ratio of the dry ear after two months of the surgery, and longer epithelial time were observed in the BMRM group than those in the atticotomy group(P<0.05). No cholesteatoma residual or recurrence was observed in both groups. Conclusion: For stage Ⅰ epitympanic cholesteatoma lateral to an intact ossicular chain, atticotomy has the advantage of complete removal of the cholesteatoma matrix, avoiding big mastoidal cavity, keeping normal anatomical structure of external auditory canal, better hearing preservation, and faster healing. Therefore, atticotomy has better clinical and practical value.
引文
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[7] 孔维佳.耳内镜手术是昙花一现还是技术革命?(Ⅱ)[J].临床耳鼻咽喉头颈外科杂志,2018,32(20):1531-1541.
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[10] QOTB M,FAWZY T,RAGAB W.Single Stage Canal Wall DownMastoidectomy with Reconstruction of the Canal Wall:5 Years' Experience in Fayoum Province,Egypt[J].J Int Adv Otol,2017,13:181-185.
[11] YUNG M.Cartilage tympanoplasty:literature review[J].J Laryngol Otol,2008,122:663-672.
[12] SANNA M,FACHARZT A A,RUSSO A,et al.Modified Bondy'stechnique:refinements of the surgical technique and long-term results[J].Otol Neurotol,2009,30:64-69.
[13] PRASAD S C,GIANNUZZI A,NAHLEH E A,et al.Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma[J]?Eur Arch Otorhinolaryngol,2016,273:2533-2540.
[14] PONTILLO V,BARBARA F,DE ROBERTIS V,et al.Treatment of cholesteatomawith intact ossicular chain:anatomic and functional results[J].Acta Otorhinolaryngol Ital,2018,38:61-66.
[15] NYROP M,BONDING P.Extensive cholesteatoma:long-term results ofthree surgical techniques[J].J Laryngol Otol,1997,111:521-526.
[16] 高芬琦,王林娥,龚树生,等.开放式乳突根治术后不干耳原因分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(7):530-533.
[17] PRASAD S C,GIANNUZZI A,NAHLEH E A,et al.Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma[J]?Eur Arch Otorhinolaryngol,2016,273:2533-2540.
[18] ALICANDRI-CIUFELLI M,ANSCHUETZ L,PRESUTTI L,et al.Letter to the Editor "Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma?" by Prasad et al[J].Eur Arch Otorhinolaryngol,2016,273:2863-2864.
[2] 孙建军,刘阳.中耳炎临床分类和手术分型指南(2012)解读[J].中华耳鼻咽喉头颈外科杂志,2013,48(1):6-10.
[3] SHAAN M,LANDOLFI M,TAIBAH A,et al.Modified Bondy technique[J].Am J Otol,1995,16:695-697.
[4] GHADERSOHI S,CARTER J M,HOFF S R.Endoscopic transcanal approach to the middleear for management of pediatric cholesteatoma[J].Laryngoscope,2017,127:2653-2658.
[5] DUCKERT L G,MAKIELSKI K H,HELMS J.Management of anterior epitympaniccholesteatoma:expectations after epitympanic approach and canal wallreconstruction[J].Otol Neurotol,2002,23:8-13.
[6] TARABICHI M.Endoscopic management of limited attic cholesteatoma[J].Laryngoscope,2004,114:1157-1162.
[7] 孔维佳.耳内镜手术是昙花一现还是技术革命?(Ⅱ)[J].临床耳鼻咽喉头颈外科杂志,2018,32(20):1531-1541.
[8] LEE W S,CHOI J Y,SONG M H,et al.Mastoid and epitympanicobliteration in canal wall up mastoidectomy for prevention of retraction pocket[J].Otol Neurotol,2005,26:1107-1111.
[9] 龙瑞清,阮标,刘卓慧,等.保留部分外耳道后壁上鼓室切开软壁重建术治疗中耳胆脂瘤[J].临床耳鼻咽喉头颈外科杂志,2018,32(1):23-27.
[10] QOTB M,FAWZY T,RAGAB W.Single Stage Canal Wall DownMastoidectomy with Reconstruction of the Canal Wall:5 Years' Experience in Fayoum Province,Egypt[J].J Int Adv Otol,2017,13:181-185.
[11] YUNG M.Cartilage tympanoplasty:literature review[J].J Laryngol Otol,2008,122:663-672.
[12] SANNA M,FACHARZT A A,RUSSO A,et al.Modified Bondy'stechnique:refinements of the surgical technique and long-term results[J].Otol Neurotol,2009,30:64-69.
[13] PRASAD S C,GIANNUZZI A,NAHLEH E A,et al.Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma[J]?Eur Arch Otorhinolaryngol,2016,273:2533-2540.
[14] PONTILLO V,BARBARA F,DE ROBERTIS V,et al.Treatment of cholesteatomawith intact ossicular chain:anatomic and functional results[J].Acta Otorhinolaryngol Ital,2018,38:61-66.
[15] NYROP M,BONDING P.Extensive cholesteatoma:long-term results ofthree surgical techniques[J].J Laryngol Otol,1997,111:521-526.
[16] 高芬琦,王林娥,龚树生,等.开放式乳突根治术后不干耳原因分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(7):530-533.
[17] PRASAD S C,GIANNUZZI A,NAHLEH E A,et al.Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma[J]?Eur Arch Otorhinolaryngol,2016,273:2533-2540.
[18] ALICANDRI-CIUFELLI M,ANSCHUETZ L,PRESUTTI L,et al.Letter to the Editor "Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma?" by Prasad et al[J].Eur Arch Otorhinolaryngol,2016,273:2863-2864.