乳突根治术失败原因分析

目的:探讨乳突根治术失败的常见原因,以提高手术治疗水平,获得干耳。方法:对28例乳突根治术后长期不干耳的患者进行再次手术。结果:28例患者经1～2个月局部换药均获得干耳。无一例眩晕、面瘫等并发症发生。结论:病灶清除不彻底、术腔引流不畅、术后换药处理不当、术腔异物遗留等是乳突根治术失败导致不干耳的原因。乳突腔充分轮廓化,显微镜下彻底清除病灶并确保术腔的引流通畅是防止再次手术的关键。     

乳突根治术后病例鼓室成形术的疗效探讨

目的 总结乳突根治术后长期流脓患者鼓室成形术的疗效.方法 对63例乳突根治术后长期不干耳患者再次施行乳突根治术,同时行乳突充填术及鼓室成形术.结果所有患者经1～2月局部换药均获干耳,外道形态接近自然宽大的外耳道,气导听力较术前获得改善.结论 病灶清除不彻底,术腔难于清理是乳突根治手术失败的主要原因.乳突腔彻底开放,轮廓化,适度充填乳突腔,配合鼓室成形术,可以获得近似正常的外耳道,并且能有效改善听力.     

乳突根治术后不干耳原因分析

乳交根治术是清除中耳乳突病灶以获得干耳的手术。乳突根治术后不干耳的情况常有发生。为提高对不干耳原因的认识，现对我种收治的34例乳穷根治术后不干耳患者的临床资料分析如下。1临床资料本组34例（3耳）中，男26例，女8例；年龄11～49岁，平均31岁。乳突根治术3～6个月后发生不于耳者5例，其余29例为术后1个月即间断或持续流脓。34例中4倒入院后检查乳突腔发现其深部有短棉纱，去除棉纱后换药治疗于耳；另外30例行乳突再根治术，术中所见情况有：胆脂瘤残留12例，炎性肉芽组织15例，异物（敷料棉纱）3例；病灶部位：上鼓室7例，后鼓室9…     

乳突根治术后不干耳原因探讨

我科近20年来收治的68例乳突根治术后不干耳病人的临床资料分析如下。1 临床资料 本组68例(68耳)中,男48例,女20例;年龄14～52岁,平均34岁。乳突根治术3～6个月后发生不干耳者12例,其余56例为术后1个月即间断或持续流脓。68例中8例来门诊检查乳突腔发现其深部有短棉纱,去除棉纱后换药,用抗生素治疗后于耳;另外60例行乳突再根治术,术中所见情况有:胆脂瘤残留24例,炎性肉芽组织30例,异物     

耳内镜在乳突根治术中术后的临床应用

目的探讨耳内镜在乳突根治术及术后换药的应用。方法应用耳内镜对26例胆脂瘤型中耳炎患者行乳突根治术及术后换药,术后所有患者均随访3个月。结果 26例患者均获得干耳,术后无1例发生眩晕,面瘫等并发症发。结论应用耳内镜行乳突根治术能彻底清除病灶,术腔引流通畅,术后干耳率高。值得在基层医院推广应用。     

耳甲腔成形及乳突腔充填术在乳突根治术中的应用价值

目的探讨耳甲腔成形术及乳突腔充填术在乳突根治术中的应用价值.方法25例、25耳行乳突腔充填术及耳甲腔成形术,分别于术后3、6个月观察乳突腔缩小情况、干耳时间、术腔上皮化及术后是否出现前庭症状等.结果经随访1～2年,患者巨大乳突术腔明显变小,皮肤光滑,色泽正常,全部病例均获干耳,干耳时间平均为6周,1例术后出现头晕,耳鸣症状,4耳同期行鼓室成形术,术后实用气导听力提高15～25dB.结论耳甲腔成形术及乳突腔充填术可以缩小乳突腔,促进乳突腔的通气引流及上皮化,提高乳突根治术的效果,同时有利于鼓室成形术.     

乳突根治术后复发的原因及再手术原因分析

目的　探讨首次乳突根治术后复发的因素及再次根治术的临床要点。方法　分析23例（23耳）行乳突再根治手术患者的门诊和住院资料,再次行根治术前的乳突CT、术式、术中情况、术后内镜及听力学检查,统计分析手术前、后气导平均言语听阈等。结果　23例患者,术中无胆脂瘤者10例,有胆脂瘤者13例,选择手术方式不正确占17.39%（4/23）,病灶残留、清除不彻底者占78.26%（18/23）,术腔引流不畅者占82.61%（19/23）,咽鼓管鼓口存在病变者占34.78%（8/23）。再次根治手术行改良乳突根治术+Ⅱ型鼓室成形术+耳甲腔成形术10耳（43.48%）,改良乳突根治术+Ⅱ型鼓室成形术2耳（8.70%）,改良乳突根治术+Ⅲ型鼓室成形术+耳甲腔成形术8耳（34.78%）,改良乳突根治术+Ⅲ型鼓室成形术+外耳道后壁重建术1耳（4.35%）,乳突根治术2耳 （8.70%）。术后术腔抗生素纱条填塞14 d,持续消炎治疗1周,嘱患者滴耳、定期返院换药等综合治疗。术后5～9周干耳,平均干耳时间7周。手术后23耳均干耳,无再次复发,术腔恢复良好,术后随访1年,21耳（91.30%）行鼓室成形术,术后鼓膜未再出现穿孔、流脓液等症状,且术后3个月的气导平均言语听阈、骨气导差均低于术前水平,两者差异均具有统计学意义（P<0.05）。结论　仔细的术前CT阅片、耳内镜及听力学评估、手术者扎实的耳显微外科基本功、术式的选择、病灶残留、术腔引流不畅、咽鼓管病变等均是乳突根治术后复发因素,如行再次手术时,应当充分认识复发原因,制定正确的手术方案以达到干耳目的。     

乳突根治术后不干耳的鼓室成形术

乳突根治术的目的是清除中耳及乳突病灶 ,并使乳突、鼓窦、鼓室和外耳道连成一个大腔 ,以利引流 ,防止颅内外并发症的产生。随着国人健康水平的提高 ,部分乳突根治术后不干耳的患者 ,希望再次手术获一干耳 ,并且提高听力。因此 ,我们对 18例乳突根治术后不干耳的患者行鼓室成形术 ,获得了满意的疗效 ,现将临床资料及治疗体会报告如下 :1　资料与方法1.1　临床资料18例患者 ,男 12例 ,女 6例 ,年龄 2 6～ 4 2岁 ,平均 35 .6岁 ,均因“胆脂瘤型中耳炎”而行乳突根治术 ,术后 1～ 5年 ,患耳仍间歇性流脓 ,听力下降。检查见患耳呈乳突根治术后改…     

碱性成纤维细胞生长因子在乳突根治术腔换药中的应用

1999年 4月至 2 0 0 1年 4月 ,我们将基因重组碱性成纤维细胞生长因子 (ｂＦＧＦ)用于乳突根治术腔换药 ,术腔创面愈合明显加快 ,缩短了换药时间 ,现报告如下。1　资料与方法1 .1 　 临床资料本组 5 2例 (左耳 31例 ,右耳 2 1例 ) ,其中男 2 9例 ,女 2 3例 ;年龄 8～ 62岁 ,平均 35岁。病程 6个月～ 1 6年。均有不同程度的耳流脓史 ,鼓膜松弛部或紧张部后上方有边缘性穿孔 ,穿孔处有豆渣样物质或肉芽 ,少数患者有耳后瘘管。 5 2例均行颞骨ＣＴ扫描示上鼓室、鼓窦或乳突有骨质破坏 ,行耳内或耳后切口乳突根治术或改良乳突根治术 ,并经病理证…     

乳突根治术后不干耳的临床研究

目的 分析研究中耳乳突根治术后不干耳的主要原因,研究再次手术为了获得干耳应该注意的问题.方法 对北京大学第三医院耳鼻咽喉头颈外科于2001-2009年间收治入院的资料完整的60例乳突根治术后不干耳患者的临床资料进行回顾性分析.结果再次手术均采用乳突再根治术及开放式鼓室成形术.随访6月～8年,60例患者均获得干耳,干耳率为100%.在手术中发现60例乳突根治术后不干耳患者中,外耳道口狭窄者53例(占88%),胆脂瘤残留者48例(占80%),术腔内肉芽增生者44例(占73.3%),面神经嵴高者40例(占66.7%).结论 乳突根治术后不干耳的主要原因为病变清除不彻底和手术缺陷.乳突根治术后要想获得干耳,术中彻底清除病灶,保证术腔的通风和引流是干耳的基本条件.     

10例先天性中耳胆脂瘤临床分析

目的：探讨先天性中耳胆脂瘤的临床特征及手术方法。方法：回顾性分析10例先天性中耳胆脂瘤患者的临床资料。5例经耳内途径行鼓室探查并一期鼓室成形术,3例行闭合式乳突根治术及鼓室成形术,2例行开放式乳突根治术及鼓室成形术。结果：术中见5例胆脂瘤局限于中后鼓室,3例位于中鼓室及上鼓室,2例病变范围广泛,侵及乳突。术后6个月平均纯音听阈为30dBHL,气骨导差在20dB以内,复查颞骨CT均未发现胆脂瘤残留和复发。结论：先天性中耳胆脂瘤病变隐匿,常于鼓室前方或后方,易破坏听骨链,导致传导性聋;影像学检查可为诊断及术式选择提供依据;早期手术治疗可获得较好的听力重建效果。     

中耳胆脂瘤和慢性化脓性中耳炎手术临床分析

目的　探讨中耳胆脂瘤和慢性化脓性中耳炎术式选择及临床效果。方法　对110例中耳乳突病变,包括中耳胆脂瘤和慢性化脓性中耳炎,根据范围显微镜下实施完壁式或开放式乳突根治,部分同时鼓室成形术,随访术后干耳状况、并发症、复发情况以及术后听力改善程度等。结果　110例患者中66例中耳胆脂瘤、44例慢性化脓性中耳炎,出现颅内外并发症者7例。手术方式：51例（46.36%）行完壁式乳突根治术,46例（41.81%）同时行鼓室成形术,59例（53.64%）行开放式乳突根治术。完壁式乳突根治术后听 力提高＞25 dB 37例（33.64%）,＞15 dB 14例（12.72%）;开放式乳突根治术后听力提高＞15 dB 5例（4.55%）,听力减退4例（3.64%）,比较手术前后言语频率区平均听阈,差异有统计学意义（P＜0.05）。术后随访1年发现开放式和完壁式两组胆脂瘤复发共4例。结论　中耳胆脂瘤与慢性化脓性中耳炎通过选择恰当手术方式可获得较好的临床疗效。     

乳突根治术后同种异体肋软骨中耳重建71例报告

目的：探讨乳突根治术后,让术耳向外耳道开放的乳突腔重新中耳化和Ｉ期听力重建的方法。方法：以同种异体肋软骨为外耳后壁重建、乳突充填和听骨链重建的材料,对７１例（耳）于乳突根治术后行中耳重建术。结果：７１耳术后经０．５￣５年随访,除２耳外,全部病例重建外耳道接近正常生理结构;听力提高１５ｄＢ以上或达应用水平５５耳（７７．５％）,听力提高未达１５ｄＢ１１耳（１５．５％）,因不同原因失败５耳（７．０％）。     

Reconstruction of the posterior auditory canal with hydroxyapatite-coated titanium.

There are a variety of techniques for treating chronically discharging radical mastoid cavities. The purpose of this article is to report the preliminary results of an original technique for reconstruction of the posterior auditory canal using a titanium net combined with porous hydroxyapatite coating. Titanium is fixed with two screws to the mastoid tip and zygomatic root to prevent the risk of implant dislocation. Eight patients with chronically discharging radical mastoid cavities that failed medical management underwent reconstruction of the mastoid cavity using this technique. After surgery, all cases had rapid healing and good aeration of the middle ear and mastoid. One tympanic membrane reperforated, and no extrusion of the prostheses were detected clinically or on computed tomography scanning. The minimum postoperative follow-up period has been 12 months (range 12-48 months). To date, there has been no evidence of cholesteatoma recurrence. The preliminary results remain encouraging. Larger series and longer follow-up, however, are advisable to prove real validity.     

骨片重建和围手术期通气治疗根治腔的效果观察

目的 探讨利用自体带骨膜的骨皮质片,修复根治后遗留的巨大腔并作听骨重建,及术后使用乳突腔充气的治疗效果。方法 回顾性分析40例手术病历资料 (再次手术3例,共43例次),均有胆脂瘤根治手术根治腔和感染流脓。术前平均气导（68.27±14.13）dBHL（AC,取0.5K,1K,2K均数,下同）,平均气骨导差（GAP）（47.02±12.72）dBHL。按照手术方法,分两组：骨片组,前20耳带骨膜骨片修复根治腔和听骨重建;充气组,另23耳（其中3耳是骨片组再手术）在前述基础上引出2mm硅胶管,在术后围手术期中加用中耳充气。随访6～60个月,平均（16.46±8.36)个月,平均气骨导差（GAP）＜20dB为成功。统计分析用U检验。结果 耳道情况：40例全部耳道呈现光滑的外观。8例有随访的CT片复查,呈现上鼓室和/或乳突腔再气化;听力结果：27例（62%）为成功, 16例为显效（37%）。骨片组3例术后听力不佳,再次手术中发现均有中上鼓室间粘连,分解后使用充气法,2例获成功。结论 带骨膜骨片有助于形成正常光滑的耳道,中耳充气有利于上鼓室再气化和听力恢复。     

Clinical Significance of β-Tricalcium Phosphate and Polyphosphate for Mastoid Cavity Obliteration during Middle Ear Surgery: Human and Animal Study

Objectives

Mastoid obliteration is used to obliterate the mastoid cavity following a mastoidectomy or to prevent the formation of a retraction pocket. This study evaluated the effectiveness of β-tricalcium phosphate and polyphosphate (β-TPP) for mastoid obliteration in middle ear surgeries in prospective human and animal studies.

Methods

Twenty patients with chronic otitis media underwent mastoid obliteration using β-TPP after a intact canal wall mastoidectomy or simple mastoidectomy. The clinical data were prospectively evaluated including: the diagnosis, temporal bone computed tomography (TBCT), otoscopic findings, pure tone audiogram, and complications. In the animal experiment, β-TPP was applied into the right bulla in five rats, and the opposite bulla was used as the control in the non-obliterated state. The skulls of five other rats were drilled out and the holes were obliterated with β-TPP. TBCT were obtained at 3, 6, and 9 months after the obliteration and histologic analysis was done at 3 and 9 months after surgery.

Results

In the human study, fourteen TBCTs were obtained at 12 months after the surgery. All demonstrated no bone resorption in the obliterated mastoids. Among the 15 cases displaying retracted tympanic membranes preoperatively, 11 showed no retraction, 2 showed retraction postoperatively, 1 was lost to follow-up and 1 was a case of postoperative wound infection. Among 20 cases, one case developed a postoperative infection that necessitated a second operation. Sixteen underwent ossiculoplasty; hearing improvements were obtained in 15 cases and 1 case showed decreased hearing. In the animal study, new bone formation without significant bone resorption in the radiologic and histologic findings were noted in both the skull and bulla groups.

Conclusion

Although β-TPP is a foreign material having the possibility of infection, mastoid obliteration with it can be a treatment option in middle ear surgeries to prevent retraction pockets or the recurrence of diseases.     

开放式鼓室成形术或乳突根治术中切除乳突尖的优点

目的：总结乳突尖部分切除在开放式鼓室成形术或乳突根治术中的作用。方法：44例胆脂瘤型中耳炎患者中，行单纯乳突根治术(10例)和开放式鼓室成形术(34例，含乳突切除术加鼓室成形术Ⅱ型或Ⅲ型)时．同时切除部分乳突尖外侧壁。结果：切除乳突尖后，乳突容积明显减小，术后3个月随访，干耳43例，占97．6％。干耳时间3周～2．5个月。术后1年随访，无一例胆脂瘤复发。结论：乳突尖部分切除在开放式鼓室成形术或乳突根治术中消灭乳突死腔，最大程度达到干耳，减少胆脂瘤复发，具有重要作用。     

Preliminary experience with beta-tricalcium phosphate for use in mastoid cavity obliteration after mastoidectomy.

OBJECTIVE: To examine the efficacy and safety of mastoid cavity obliteration using highly purified beta-tricalcium phosphate (beta-TCP) after mastoidectomy in middle ear surgery. PATIENTS: Thirteen patients with cholesteatoma invading the mastoid cavity or showing severe pathologic changes in the mastoid cavity. INTERVENTION: Twelve patients underwent mastoid obliteration with highly purified beta-TCP during the first- and/or second-stage operation of a 2-stage canal-up operation: 5 patients during the first and second stages, and 7 patients during the second stage only. One patient with cholesteatoma underwent mastoid obliteration with highly purified beta-TCP during a 1-stage canal-up operation. In total, beta-TCP was applied in 18 ear operations. MAIN OUTCOME MEASURES: All patients underwent multislice computed tomography (CT) before and after surgery to assess the condition of the middle ear. The amount of residual beta-TCP granules in the mastoid cavity was assessed using the following granular shadow grading scale: Grade 0, no granular shadow in the mastoid cavity; Grade 1, residual granular shadows in part of the mastoid cavity; and Grade 2, granular shadows in most of the mastoid cavity. To assess any harmful effect of beta-TCP implanted in the mastoid cavity, continuous postoperative discharge and delayed wound healing were recorded. In addition, the bone conduction threshold was assessed using pure-tone audiometry, and the patients were asked whether they experienced vertigo or dizziness during the postoperative follow-up. RESULTS: All the patients who underwent multislice CT less than 11.4 months after mastoid cavity obliteration with beta-TCP were Grade 2 on the granular shadow grading scale, whereas all those who underwent multislice CT more than 53.8 months after mastoid obliteration were Grade 0. No patient had continuous postoperative discharge, delayed wound healing, or extrusion of beta-TCP granules. No patient showed deterioration of the bone conduction threshold more than 10 dB after mastoid cavity obliteration with highly purified beta-TCP or complained of postoperative vertigo or dizziness. CONCLUSION: Highly purified beta-TCP may be safe and reliable for mastoid obliteration. Highly purified beta-TCP may also be useful in other surgical procedures, including posterior wall reconstruction of the external auditory canal and scutum plasty.