上鼓室重建及鼓室成形术在开放式乳突根治中的应用

目的 探讨重建上鼓室外侧壁在开放式乳突根治中的意义。方法 选择开放式乳突根治的病人，同时应用同种异体鼻中隔软骨或自体乳突皮质骨，重建上鼓室外侧壁，完成上鼓室成形术20例。结果 20例手术均获得干耳，术后3～6个月平均气导听力提高20dB以上4耳，l0～20dB 13耳。结论 应用同种异体鼻中隔软骨或自体乳突皮质骨，重建上鼓室外侧壁，能改善行开放式乳突根治病人的听力。     

乳突腔充填术在开放式鼓室成形术中的应用

目的 :探讨乳突腔充填术在开放式鼓室成形术中对恢复生理性外耳道功能的作用。方法 :对行开放式鼓室成形术的 85例 85耳胆脂瘤型中耳炎 ,以乳突皮质骨、同种异体软骨和 U形肌骨膜瓣同期行乳突腔充填。听骨链重建情况 :因骨导域值增高或行阶段性手术未作听骨链重建 10耳 ,鼓室成形术改良 型 40耳 ,改良 型35耳。结果 :总听觉改善率 76 % ,其中改良 型为 80 % ,改良 型为 71.4%。术后干耳率为 97.6 % ,平均干耳时间(19.86± 5 .31) d。术后随访半年以上 ,具有圆滑外耳道以及良好自净作用的占 89.4%。未见胆脂瘤复发病例。结论 :对没有条件行完壁式鼓室成形术的胆脂瘤型中耳炎 ,行乳突充填可以有效地克服开放式鼓室成形术破坏生理外耳道结构的不足 ,保存外耳道皮肤的自净作用 ,提高患者术后的生活质量。     

上鼓室进路并外耳道及鼓室成形术的临床分析

目的:观察上鼓室切开结合外耳道和鼓室成形术治疗主要局限于上鼓室胆脂瘤的临床疗效。方法:采用上鼓室进路治疗31例病灶主要限于上鼓室的胆脂瘤患者,并于清除病灶后,用耳屏或耳甲腔软骨/软骨膜行外耳道成形和鼓室成形术,重建上鼓室外侧壁和恢复传音结构。结果:经上鼓室外侧壁重建和鼓室成形术后,除2耳鼓室硬化者外,余听力都有提高或保持正常状态,仅有1例出现鼓膜穿孔,31例均未发现囊袋状内陷或胆脂瘤再发。结论:上鼓室切开进路,I期用软骨/软骨膜行外耳道成形和鼓室成形术,较好地恢复了外耳道及中耳结构形态和功能,对治疗局限于上鼓室的胆脂瘤和防止复发的效果好。     

乳突腔充填术在开放式鼓室成形术中的应用

本文应用乳突骨骼化时保留的乳突骨皮质骨粉充填乳突术腔和上鼓室腔,减小乳突及上鼓室开放术腔,以形成接近生理状态下的外耳道,使术腔引流通畅,提高了干耳率,减少了术后复发及术腔肉芽生长。1资料与方法1.1临床资料2002～2006年行开放式鼓室成形术的中耳炎患者28例,男16例,女12     

软骨填塞封闭上鼓室缺损技术在中耳胆脂瘤手术中的应用

目的　在中耳胆脂瘤手术中,为防止术后上鼓室胆脂瘤凹陷袋形成,以软骨封闭上鼓室回顾分析了这一临床技术、外科适应证及软骨在防止胆脂瘤复发中的应用价值。方法　本文回顾分析2014年4月～2019年12月因中耳胆脂瘤接受治疗的63例（63耳）患者。基本术式为乳突切开术,保留外耳道后壁但同时切除上鼓室外侧壁,以充分暴露并清理病变,缺损的上鼓室以软骨填塞封闭,防止术后 上鼓室内陷袋形成,以避免胆脂瘤复发。软骨取自耳廓,切成条块状修复上鼓室缺损。本文术后随访检查包括软骨愈合情况、上鼓室回缩袋形成及胆脂瘤复发情况,不涉及听力。结果　全部病例术后随访时间1年以上。63例中,18例（28.6%）术后出现不同程度并发症,3例软骨缝隙过大,缝隙处局部胆脂瘤痂皮,门诊清理;6例术后检测咽鼓管功能不良,软骨缝隙处回缩局部胆脂瘤痂皮,但无内陷袋形成;3例上鼓室及中上鼓室交界处不同程度凹陷,胆脂瘤生成,但被软骨阻挡,未再发展;3例鼓膜边缘穿孔未愈合,鼓室内感染;3例术后胆脂瘤复发,由上鼓室向鼓窦和乳突方向发展。结论　在中耳乳突手术中,切除上鼓室充分暴露术区病变并彻底清除病灶后,缺损的上鼓室填塞封闭可有效防止回缩袋的形成,避免胆脂瘤复发。而软骨在术中取材、雕刻塑形、手术操作、术后抗感染能力、预防和阻止上鼓室处胆脂瘤的发生和发展均具有较强优势。     

开放式乳突切开+鼓室成形术中乳突填塞材料的应用进展

开放式乳突切开+鼓室成形术是一种治疗中耳胆脂瘤和慢性化脓性中耳炎等疾病的有效外科手术技术,旨在彻底清除病灶,从而达到干耳、促进病灶引流、避免颅内外并发症发生的目的。但手术遗留的大乳突空腔可能导致术耳反复流脓、术后需定期清理痂皮、与温度变化有关的前庭功能紊乱、继发术腔感染和隐形助听器佩戴不方便等问题,严重影响患者的生活质量。因此,乳突缩窄术对提高开放式乳突切开+鼓室成形术后疗效是非常重要的。随着医学技术的进步和材料科学的不断发展,越来越多的材料被临床医生应用到乳突缩窄术的临床实践当中,但各种材料的取材方式、组织量、是否容易存活和吸收等特点各不相同,各有优缺点。因此,论文就乳突缩窄术在开放式乳突切开+鼓室成形术中的应用及乳突填塞材料的选择进行综述。     

自体骨粉上鼓室重建在鼓室成形术中的应用

1在开放式乳突根治后行鼓室成形术中,我们采用了自体乳突皮质骨粉重建上鼓室结构,获得了良好效果,现报告如下。1材料与方法本组40例中,男22例,女18例;年龄16～59岁,平均37.3岁;病程半年～30余年;双耳13例,左耳16例,右耳11例;左耳手术23例,右耳17例。病理诊断为慢性骨疡型中耳炎     

开放式鼓室成形术中上鼓室的处理

自1992年3月至1995年5月，共对50例慢性化脓性中耳乳突炎（骨疡型，胆脂瘤型）患者施行开放式鼓室成形术。提高听力30dBHL的为16％，20dBHL的为56％，10dBHL的为16％，保持原听力的为12％。术后经1－4年随访无上鼓室内陷袋形成鼓室粘连。复发率2％。本文就手术方法、体会、经验进行讨论。     

透明质酸在鼓室成形术中的应用

报告对２３例病人行鼓室成形术中应用透明质酸，以加速术后创口愈合，２２例取得了良好的疗效，移植鼓膜成活率高，创面修复快，愈合后鼓膜萎缩率低，且可减轻术后听骨粘连，使病人听力稳定提高，表明ＨＡ值得在耳科领域推广应用。     

耳屏软骨-软骨膜在鼓室成形术中的应用

目的探讨用耳屏软骨-软骨膜行鼓室成形术的疗效。方法对52例(52耳)鼓膜穿孔患者用自体耳屏软骨-软骨膜复合体重建鼓膜,并根据听骨链是否完整及鼓膜是否残存而采取了不同的术式,并于1年后复查纯音听阈,对结果进行分析。结果52耳手术后一个月鼓膜穿孔均愈合。术后随访1～3年,除3耳鼓膜再穿孔外,余均愈合,纯音测听示术后较术前气骨导差平均缩小16dB。结论耳屏软骨-软骨膜复合体是修复鼓膜大穿孔的理想材料,其远期愈合率高,听力恢复满意,效果稳定。     

Clinical Results of Atticoantrotomy with Attic Reconstruction or Attic Obliteration for Patients with an Attic Cholesteatoma

Objectives

We aimed to investigate the clinical results of atticoantrotomy in patients with an attic cholesteatoma.

Methods

Ninety-eight ears in 98 patients were operated on using atticoantrotomy between October 2002 and December 2006. A retrospective review of the otology database (operative findings and methods, postoperative physical examination and pre- and postoperative audiometry) was performed.

Results

There were 58 female and 40 male patients with a mean age of 40 yr. The cholesteatoma was limited to the attic region in 24 patients (24.5%); attic with antrum in 18 (18.4%); and attic with antrum and middle ear in 56 (57.1%). Attic obliteration was performed in 59 patients (60.2%), attic reconstruction in 39 (39.8%) and ossicular reconstruction was performed in 59 (60.2%). The mean preoperative and postoperative air-bone gaps were 29.2±13.5 dB and 25.0±15.4 dB, respectively (P=0.01) and the mean preoperative and postoperative high-tone bone conduction levels were 14.5±9.7 dB and 15.23±14.0 dB, respectively (P=0.411). A recurrent cholesteatoma was detected in 3 ears (3%) and revision surgery was performed on these patients.

Conclusion

Atticoantrotomy showed a low recurrence rate and no deterioration in hearing levels. If there is a intact malleus head or body of incus, attic reconstruction was possible and this procedure could lead to improved hearing. However, postoperative retraction occurred in 18% of patients, a problem that will need to be solved in the future.     

栅状软骨用于鼓室成形术的临床研究

目的：对传统的鼓室成形术即Wullstein术式做进一步改进。方法：采用自体耳廓基底部软骨剪成1－1．5mm细条状，紧贴听小骨及鼓环成栅栏状排列，外覆以外耳道转移皮瓣及残余鼓膜，治疗慢性化脓性中耳炎鼓膜穿孔40例（42耳）。结果：随访半年１－８年未见胆脂瘤复发及其它并发症发生，移植鼓膜全部愈合。纯音听力提高30－40dB和／或骨、气导差小于10dB 共41耳（97．62％），听力无明显提高者1耳（2．38％）。结论：改进的术式便于手术操作，取材方便，对提高鼓室成形术的质量及成功率具有重要的意义。     

年龄因素对鼓室成形术效果的影响

目的 通过对40例（40耳）60岁以上患者和40例（40耳）60岁以下患者进行鼓室成形手术,对手术后听力效果进行分析。方法 手术前均进行了纯音测听检查,60岁以上年龄组气导听力阈值55dB,60岁以下年龄组气导听力阈值39dB。慢性化脓性中耳炎单纯性24例（24耳）,胆脂瘤型中耳炎29例（29耳）和中耳炎后遗症27例（27耳）。手术均在全麻下进行,采取了乳突根治加鼓室成形术26耳、鼓室探查术54耳。术中采取Ⅰ型鼓室成形23耳：改良Ⅱ型25耳和改良Ⅲ型32耳鼓室成形术。结果 60岁以上年龄组手术后平均气导听力46dB,手术成功率67％。60岁以下年龄组术后平均气导听力33dB,手术成功率70％。统计学t检验结果：两组仅在术后气导听力阈值的结果中,有随着年龄增长而增高的趋势。结论 手术成功率与病程长短及病变部位有关,高龄患者为了提高生活质量还应积极进行鼓室成形手术。     

仅存单侧听力耳的鼓室成形术

目的 :探讨仅存单耳听力胆脂瘤根治和听力重建的可行性。方法 :回顾分析 1990～ 2 0 0 0年间在我院手术的 15例仅存单耳听力的传导性耳聋手术后的听力改善情况。鼓室成形Ⅲ型 6耳 ,Ⅰ型 5耳 ;乳突或上鼓室根治 4耳 ,其中 3耳同时行鼓室成形Ⅲ型 ,1耳仅作复发的胆脂瘤清除。结果 :15耳均干耳。除 3耳听力不变或气骨导差缩小不足 10dB外 ,余 12耳 (80 %)均有不同程度的提高。缩小 30dB以上的 2耳 ,2 0dB以上 6耳 ,10dB 4耳 ,P <0 .0 1。无一耳发生术耳感音功能下降。结论 :对于仅存单侧听力的胆脂瘤型中耳炎根治和听力重建是可行的 ,但需加倍小心谨慎 ,动作要轻柔 ,最大程度地减少对内耳的扰动 ,并由经验丰富的医师担当手术。     

玻璃酸钠在鼓室成型术中应用的疗效观察

报告在鼓室成型术中一次性应用玻璃酸钠注射液充填鼓室,共手术25例.治愈者76%(19/25),良好者20%(5/25),较差者4%(1/25),总有效率96%(24/25).经门诊随访1年,鼓膜无内陷、粘连及听力下降.该品特点有高粘弹性及访形性,无毒副作用,可一次性充填鼓室,操作简便,术后并发症少,提高了手术成功率,有较好的临床应用价值.     

单侧听力耳鼓室成形术的临床探讨

目的分析单侧听耳患者的鼓室成形术,了解手术方法和手术疗效。方法对9耳慢性化脓性中耳炎胆脂瘤型进行了乳突根治术加鼓室成形术,对37耳慢性化脓性中耳炎单纯型和中耳炎后遗症进行鼓室成形术,并比较术后效果。手术后3个月~1年之间进行术后听力评价。结果46耳单侧听力耳术前言语频率气导平均听阈为60.2±23.1dB HL,骨导听阈35.7±17.0dB HL;手术后的平均气导听阈为51.3±22.6dB HL,骨导听阈为36.3±10.6dB HL。鼓室成形术后疗效评定:37耳外耳道宽敞,人工鼓膜完整,血运好,近正常鼓膜色泽;纯音测听500~2000Hz平均气导听力改善23例(62.16%,23/37),听力不变13例(35.14%,13/37),听力恶化(下降10dB以上)1例(2.70%,1/37)。乳突根治术加鼓室成形术后疗效评定:9耳术腔干洁,人工鼓膜完整,血运好,近正常鼓膜色;纯音测听500~2000Hz平均气导听力改善5例(56.56%,5/9),听力不变4例(44.44%,4/9)。结论各型慢性化脓性中耳炎都可作为单侧听力耳的手术适应症。手术时只要注意手术技巧,认真仔细,一般不会造成手术后骨导听力的下降。术后干耳和保持原有听力是手术的最终目的。     

Tympanoplasty in children

Closure of uncomplicated tympanic membrane perforation (tympanoplasty) is usually a straightforward procedure with a good success rate. Many studies report a success rate from 60 to 99% in adults, whereas a 35–94% success rate in children. The definition of successful tympanoplasty varies from one author to other. Some authors report that an intact tympanic membrane considered a successful surgical result, whereas the other authors may also consider the postoperative hearing, as well as middle ear aeration, as a part of good outcome. This review is an insight into the recent and as well as the past literature on prognostic factors in pediatric tympanoplasty. This article reports an overview of the commonly reported factors which are thought to affect the tympanoplasty in children. Age is considered as one of the most important factor determining the successful outcome of tympanoplasty. Most of the studies did not reveal any significant difference in result between pediatric tympanoplasty from those of adult ones. Interestingly, in one study; it was found that patients younger than 16 years had decreased graft uptake compared with adults. However, in this same study; it was found that the younger patients had better postoperative hearing with better postoperative AB gap closure. The other factors which seem to influence the success rate of tympanoplasty are the size of perforation, technique used, presence or absence of otorrhoea, eustachian tube function and status of the contralateral ear. A study has revealed that posterior perforation had poorer results but it may be a distorted finding as the surgical method was not controlled. Regarding the size of perforation and its influence on the success rate of tympanoplasty, there is again difference of opinion. In one study, it was found that perforations greater than 50% had poorer results, but other studies contradict this statement stating that the success of tympanoplasty has no bearing with the size of perforation. Poor eustachian tube function has been offered as an explanation by some authors as younger age may be correlated with lower tympanoplasty success rates, but some authors refute this by stating that poor eustachian tube function not necessarily an indicator of poor surgical outcome. In conclusion, the success of tympanoplasty in children, with little doubt, depends on a number of factors. The past and recent literature has not produced a consensus of convincing evidence supporting any one parameter.