中耳胆脂瘤术中开放管上隐窝通道的方法及术后疗效分析
摘要
目的探讨中耳胆脂瘤术中打通咽鼓管上隐窝及上鼓室膈的意义。方法将2013年6月～2016年12月住院手术的中耳胆脂瘤患者65例(67耳)根据术式分为三组:完璧式乳突切开组(简称完璧组)16耳,术前语频平均听阈46.6±17.5 dB HL,气骨导差(ABG)24.8±7.8 dB,保留上鼓室外侧壁及外耳道后壁完整性,术中相应开放管上隐窝通道及后鼓室通道;上鼓室切开组11耳,术前平均听阈39.1±10.5 dB HL,ABG 19.0±7.2 dB,开放管上隐窝通道;乳突开放缩窄组40耳,术前平均听阈49.1±18.8 dB HL,ABG 26.0±9.2 dB,行乳突根治术,骨粉填塞部分乳突腔,不处理管上隐窝。术后随访1年,观察各组疗效。结果术后1年,完璧组干耳率为100%(16/16),复发率为0,听力提高率为87.5%(14/16),气导平均听阈为30.5±10.1 dB HL,ABG为10.9±5.2 dB;上鼓室切开组干耳率为100%(11/11),复发率为0,听力提高率为100%(11/11),气导平均听阈为23.3±7.5 dB HL,ABG为8.1±4.3 dB;乳突开放缩窄组干耳率为97.5%(39/40),复发率为5%(2/40),听力提高率为72.5%(29/40),气导平均听阈为35.3±9.8 dB HL,ABG为12.5±5.7 dB。结论中耳胆脂瘤术中开放管上隐窝有利于中耳及乳突的气体交换,可提高疗效,减少胆脂瘤复发的可能性。
引文
1 Di Lella F,Bacciu A,Pasanisi E,et al.Clinical findings and surgical results of middle ear cholesteatoma behind an intact tympanic membrane in adults[J].Acta Biomed,2016,87:64.
2 Prasad SC,Lameli AC,Medina M,et,al.Long-term surgical and functional outcomes of the intact canal wall technique for middle ear cholesteatoma in the paediatric population[J].Acta Otorhinolaryngol Ital,2014,34:354.
3 Sajjadi H.Endoscopic middle ear and mastoid surgery for cholesteatoma[J].Iran J Otorhinolaryngol,2013,25:63.
4 Presutti L,Gioacchini FM,Alicandri-Ciufelli M,et,al.Results of endoscopic middle ear surgery for cholesteatoma treatment:a systematic review[J].Acta Otorhinolaryngol Ital,2014,34:153.
5 姜学钧,魏宏权,惠莲,等.胆脂瘤中耳炎与咽鼓管上隐窝[J].中华耳鼻咽喉头颈外科杂志,2007,42:491.
6 Uluyol S,Ugur O,Arslan IB,et al.Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy[J].Braz J Otorhinola-Rynqol,2017.doi:10.1016/j.bjorl.2017.07.007.
7 Alves RD,Cabral Junior F,Fonseca AC,et al.Mastoid obliteration with autologous bone in mastoidectomy canal wall down surgery:a literature overview[J].Int Arch Otorhinolaryngol,2016,20:76.
8 Bakaj T,Zbrozkova LB,Salzman R,et al.Recidivous cholesteatoma:DWI MR after canal wall up and canal wall down mastoidectomy[J].Bratisl Med J,2016,117:515.
9 杨名保,赵海亮,柴福,等.重建上鼓室外侧壁的保留骨桥乳突切开鼓室成形术[J].中华耳科学杂志,2016,14:625.
2 Prasad SC,Lameli AC,Medina M,et,al.Long-term surgical and functional outcomes of the intact canal wall technique for middle ear cholesteatoma in the paediatric population[J].Acta Otorhinolaryngol Ital,2014,34:354.
3 Sajjadi H.Endoscopic middle ear and mastoid surgery for cholesteatoma[J].Iran J Otorhinolaryngol,2013,25:63.
4 Presutti L,Gioacchini FM,Alicandri-Ciufelli M,et,al.Results of endoscopic middle ear surgery for cholesteatoma treatment:a systematic review[J].Acta Otorhinolaryngol Ital,2014,34:153.
5 姜学钧,魏宏权,惠莲,等.胆脂瘤中耳炎与咽鼓管上隐窝[J].中华耳鼻咽喉头颈外科杂志,2007,42:491.
6 Uluyol S,Ugur O,Arslan IB,et al.Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy[J].Braz J Otorhinola-Rynqol,2017.doi:10.1016/j.bjorl.2017.07.007.
7 Alves RD,Cabral Junior F,Fonseca AC,et al.Mastoid obliteration with autologous bone in mastoidectomy canal wall down surgery:a literature overview[J].Int Arch Otorhinolaryngol,2016,20:76.
8 Bakaj T,Zbrozkova LB,Salzman R,et al.Recidivous cholesteatoma:DWI MR after canal wall up and canal wall down mastoidectomy[J].Bratisl Med J,2016,117:515.
9 杨名保,赵海亮,柴福,等.重建上鼓室外侧壁的保留骨桥乳突切开鼓室成形术[J].中华耳科学杂志,2016,14:625.