保留骨桥的乳突鼓室成形术及软壁外耳道重建治疗胆脂瘤中耳炎

目的 探讨并评价保留骨桥的乳突鼓室成形术及软壁外耳道重建治疗胆脂瘤中耳炎的临床效果.方法 对67例(69耳)胆脂瘤中耳炎患者施行保留骨桥的乳突鼓室成形术(IBM)及软壁外耳道重建,手术开放鼓窦、乳突及上鼓室,切除骨性外耳道后壁,经面隐窝开放后鼓室,完全清理不可逆病变,为保持中耳腔容积,保留低位骨桥;同时应用带蒂耳后肌骨膜瓣-外耳道皮瓣复合瓣填充乳突术腔并重建了外耳道,并同期或分期行鼓室成形术.结果 随访24个月以上,干耳时间16～35d(平均23.1±3.4d),语频区气骨导差平均缩小(25.3±6.7)dB HL,术后基本恢复了外耳道的解剖形态及正常生理功能.结论 IBM手术及软壁外耳道重建在根除病灶的基础上保存或提高了听力,并恢复了外耳道基本形态及功能,为治疗胆脂瘤中耳炎较佳的选择.     

耳后双蒂肌骨膜瓣在大乳突腔填塞中的应用

目的探讨耳后双蒂肌骨膜瓣在乳突根治术中,填塞乳突腔对干耳及听力疗效的观察。方法对慢性中耳炎患者行乳突根治术、鼓室成形术和耳甲腔成形术78例（耳）中,进行耳后双蒂肌骨膜瓣填塞乳突腔。结果78例患者中,患耳干耳时间缩短至10～15天,58例听力较术前提高（17．2±4．9）dB。结论耳后双蒂肌骨膜瓣填塞对术后乳突腔的迅速上皮化、易干耳、重建外耳道后壁以及术后听力的提高具有一定的疗效。     

肌骨膜瓣填塞乳突腔、耳甲腔成形并一期鼓室成形术

目的观察对慢性化脓性中耳乳突炎(胆脂瘤或骨疡型)患者行耳后肌骨膜瓣填塞乳突腔、耳甲腔成形、WullsteinⅢ型鼓室成形术的手术疗效.方法采用耳后切口对37例(37耳)慢性化脓性中耳乳突炎(胆脂瘤或骨疡型)病人施行耳后肌骨膜瓣填塞乳突腔及耳甲腔成形和Ⅲ型鼓室成形术.结果术后听力平均提高16dB,26耳平均听力达35.8dB,9耳平均听力达25dB.跟踪随访2-4年,术腔均上皮化好,外耳道无痂皮堆积.26例鼓膜形态完全正常,5例鼓膜疤痕内陷,3例鼓膜穿孔但干耳,干耳率91.9%(34/37);3耳仍有间断性流脓,经再次手术干耳,2例胆脂瘤复发,复发率5.4%(2/37).干耳时间在5-9周,平均6.5周.结论耳后肌骨膜瓣填塞乳突腔、耳甲腔成形并Wullstein Ⅲ型鼓室成形术能使术腔迅速上皮化、易干耳,术后听力提高.     

耳甲腔成形术在软骨环-软骨膜鼓室成形术中的意义

目的 观察对胆脂瘤中耳炎患者行乳突病变切除术、软骨环-软骨膜鼓室成形术同时行耳甲腔成形术的疗效.方法 胆脂瘤中耳炎患者77例,其中41例(41耳) (治疗组)采用耳后切口施行乳突根治术、软骨环-软骨膜鼓室成形术及耳甲腔成形术;对照组36例(36耳)采用耳后切口施行乳突根治术、软骨环-软骨膜鼓室成形术.分别于术后1个月、3个月、1年及 3 年追踪观察两组患者干耳情况并行纯音听阈检查,对结果行统计学分析.结果 治疗组术前气导平均听阈为45.66±8.40 dB HL,骨气导差为26.05±8.15 dB,术后3年气导平均听阈为23.55±7.10 dB HL,骨气导差为10.79±5.52 dB.平均干耳时间24.25± 5.37天,治愈率100%.未发生外耳道狭窄.对照组术前气导平均听阈为43.78±9.25 dB HL,骨气导差为25.65±8.55 dB,术后3年气导平均听阈为29.33±8.32 dB HL,骨气导差为17.10±6.62 dB,12例发生外耳道狭窄,其中有8例胆脂瘤复发,干耳时间32.35±15.60天.结论 乳突根治术+软骨环-软骨膜鼓室成形术同时行耳甲腔成形术能使术腔迅速上皮化、易干耳,术后听力提高,效果满意.     

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。     

耳后肌骨膜瓣在开放式中耳乳突手术中的应用

目的 探讨在开放式中耳乳突手术中应用缩小乳突术相关的耳后肌骨膜瓣效果.方法 总结2005年7月～2007年8月之间,在开放式中耳乳突手术中应用耳后肌骨膜瓣、耳道后壁皮瓣、耳甲腔成形治疗中耳炎患者36例的临床资料,其中,慢性化脓性中耳炎4例;胆脂瘤中耳炎32例;术前500、1 000、2 000 Hz气导平均听阈58.5 dB HL,骨导平均听阈25.5 dB HL;行开放式中耳乳突病变切除加鼓室成形术34例,其中Ⅰ期鼓室成形听骨链重建的患者15例;Ⅱ期鼓室成形术的患者19例;行开放式乳突病变切除术的患者2例.结果 术后全部患者术腔均上皮化,术腔平滑,无死角,乳突腔明显缩小甚至消失,半年后测量外耳道的总容积平均≤1.8 ml.15例时行鼓室成形听骨链重建的患者,术后半年500、1 000、2 000 Hz气导平均听阈28.3 dB HL,骨导平均听阈19.5 dB HL.结论 应用耳后肌骨膜瓣在开放式中耳乳突手术中,缩小术腔维持外耳道的正常生理功能.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

二次开放式乳突根治术的远期疗效

目的探讨慢性中耳炎首次乳突根治术后持续不干耳的原因及再次开放式乳突根治术施行乳突腔填塞、外耳道后壁重建及鼓室成形术的远期疗效。方法收集外院曾行经典开放式乳突根治术后长期不干耳患者14例(14耳),采用带血管蒂的耳后软组织瓣及颞肌瓣填塞乳突腔,取乳突骨皮质重建上鼓室及外耳道后壁,有适应证者同期行鼓室成形术。结果二次开放式乳突根治术后随访1～5年,14耳均保持干耳,外耳道形态大致正常或略扩大。结论二次开放式乳突根治术在分析首次手术失败原因的基础上加以改进,其优点为:①术后基本无乳突腔,外耳道形态近正常或略扩大,有利于保持干耳;②有适应证者均同期行鼓室成形术,有利于改善听力。乳突腔填塞、外耳道后壁重建及鼓室成形术值得推广。     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

筋膜外植法鼓室成形术的手术体会

目的 探讨筋膜外植法在鼓室成形术中的应用及价值.方法 回顾分析筋膜外植法鼓室成形术63耳,随访观察患者的外耳道宽敞度、鼓膜形态及听力恢复情况.结果 本组病例包括中耳胆脂瘤25耳,慢性化脓性中耳炎38耳.手术方式分别为筋膜外植法鼓室成形术、筋膜外植法鼓窜成形术+完肇式乳突根治术和筋膜外植法鼓室成形术+开放式乳突根治术三种类型,中耳胆脂瘤和慢性化脓性中耳炎患者实施三种手术的数最分别为4、17、4耳和19、18、1耳.术后切口全部Ⅰ期愈合.随访0.5～3.5年,外耳道宽敞,鼓膜形态良好,听力提高或维持术前水平,未有听力下降者.按时随访者未发现有明显并发症.结论 筋膜外植法鼓室成形术具有操作流程规范、术野暴露充分、病变清除彻底等优点,在慢性中耳炎的外科治疗中具有积极意义.     

分期鼓室成形术临床疗效观察

目的：探讨分期鼓室成形手术治疗慢性化脓性中耳炎和胆脂瘤病中耳炎的临床特点和疗效。方法：回顾性分析132耳用该方法治疗的患者（分期成形组）,并与同期325耳一期成形的患者（一次成形组）做疗效比较。以术后听力提高程度（ABG值）、胆脂瘤再发率、鼓膜再穿孔率和术后不干耳率为疗效指标。结果：分期鼓室成形组ABG值28．4dB,鼓膜再穿孔率1．5％,胆脂瘤复发率0％,术后不干耳率0％;一次成形组ABG值21．3dB,鼓膜再穿孔率2．2％,胆脂瘤再发率4．0％,术后不干耳率1．2％。结论：分期成形组的术后听力提高程度、胆脂瘤复发率显著优于一次成形组。鼓膜再穿孔率和术后不干耳率差异无统计学意义。所以利用分期手术可有效地挽救和提高大部分慢性化脓性中耳炎患者的术后听力。     

外耳道后壁和上鼓室外侧壁重建并鼓室成形术的临床应用

目的探讨外耳道后壁和上鼓室外侧壁同期重建在鼓室成形术中的意义。方法30例（31耳）慢性化脓性中耳炎患者,骨性外耳道预先取骨备用。清除病灶后进行外耳道后壁和上鼓室外侧壁重建,并行I期行鼓室成形术。结果术后随访3个月～1年,31耳均获得干耳;外耳道形态接近正常,保留含气乳突腔。术后平均气导听阈提高〉20dB以上者22耳,提高10-20dB者8耳,提高〈10dB者1耳。结论同期行外耳道后壁和上鼓室外侧壁重建并I期行鼓室成形术,有助于修复乳突根治术后遗留的乳突空腔或大外耳道,有助于改善听力。     

后鼓室病灶清理对干耳影响的临床研究

目的:探讨中耳手术中常规开放后鼓室对术后干耳的影响。方法:回顾性分析168名中耳手术病例,按术中是否开放后鼓室分组,比较2组术后干耳率。结果:未开放后鼓室组和开放后鼓室组术后干耳率分别为81.7%(67/82)和91.9%(79/86);未开放后鼓室组中胆脂瘤型和骨疡型患者干耳率分别为78.9%(30/38)和84.1%(37/44),开放后鼓室组这2型干耳率分别为88.1%(37/42)和95.5%(42/44);未开放后鼓室组中行乳突根治术和鼓室成形术患者术后干耳率分别为81.8%(36/44)和84.6%(31/38),而开放后鼓室组则分别为91.3%(42/46)和92.5%(37/40)。结论:中耳手术中常规开放后鼓室不仅有利于清理隐匿的病灶,而且有利于最大限度的修低面神经嵴,通畅引流,最终提高术后干耳率。     

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。     

乳突腔同种异体牙充填在开放式鼓室成形术中的应用

目的 :探讨乳突腔同种异体牙充填并上鼓室外侧壁重建的开放式鼓室成形术的手术疗效。方法 :对5 2例 (5 2耳 )胆脂瘤型及骨疡型中耳炎患者 ,根治病灶后 ,以同种异体牙乳突腔充填并上鼓室外侧壁重建 ,同期行开放式鼓室成形术。结果 :术后 4 8耳外耳道形态接近正常生理状态 ;4 6耳鼓膜移植物生长良好 ;干耳率 92 .3% ,干耳时间平均 (17.6± 4 .2 )d。术后气导听力提高在 15dBHL以上者为 4 1耳 ,气骨导差小于 2 0dBHL者为 31耳。结论 :乳突腔同种异体牙充填并上鼓室外侧壁重建的开放式鼓室成形术 ,可较好地恢复外耳道和中耳的解剖结构和生理功能 ,听力提高远期效果显著     

保留乳突的改良完壁式鼓室成形术的临床疗效观察

目的 探讨局限于上鼓室区病变的慢性化脓性中耳炎、中耳胆脂瘤行上鼓室径路保留乳突的改良完壁式鼓室成形术的长期临床疗效.方法 诊断慢性化脓性中耳炎、中耳胆脂瘤47例(47耳)患者,结合患者专科检查,依据手术方式不同分A、B两组,A组行上鼓室径路保留乳突的改良完壁式鼓室成形术,B组行完壁式乳突切开+鼓室成形术.术后随访5～7...     

Five years experience using the intact canal wall tympanoplasty with mastoidectomy for cholesteatoma: Preliminary report.

Many advances have occurred in the treatment of acute suppurative inflammation of the middle ear; however, the problem of chronic otitis media with cholesteatoma still persists today. This paper deals with the author's experience over 5 years using the intact canal wall tympanoplasty with mastoidectomy treatment in chronic otitis media with particular emphasis on the treatment of cholesteatoma both in adults and children. From May 1, 1976 to May 1, 1981, 204 ears were operated on for chronic otitis media with the tympanoplasty with mastoidectomy technique. Of this group, 104 ears were operated on using the intact canal wall technique when there was cholesteatoma present. The major emphasis of this paper will be to evaluate those ears with cholesteatoma. The technique of the procedure used and modifications that have been made are outlined with particular reference as to why modifications were made as problems arose while observing this group of patients. The results of this study suggest that there is a greater incidence of recurrence of cholesteatoma using the intact canal wall technique in children than in adults. It is believed that this higher rate is due to ongoing eustachian tube difficulties present in children. It is also felt that the intact canal wall technique does provide a better chance of auditory functional rehabilitation than an open cavity ear procedure. The problem of residual cholesteatoma still exists using the intact canal wall procedure; however, the problem seems to be well taken care of using a planned two-stage procedure. This is particularly necessary because two-thirds of all residual cholesteatoma was found to be in the middle ear. The conclusions of the study suggest that a planned two-stage intact canal wall tympanoplasty with mastoidectomy can accomplish the goals of cholesteatoma surgery, i.e., control of the disease and improved functional results. It is felt that, if cholesteatoma recurs in a child, the revision operation should be converted to a properly performed open cavity procedure. It was felt that the anatomic removal of the posterior bony canal wall in an open cavity procedure does not render an ear safe from further problems.     

Soft-wall reconstruction of the canal wall with retrograde bone work for pediatric cholesteatoma: Long-term results

ObjectiveTo retrospectively evaluate the long-term results of surgery for retrograde bone work, using soft-wall reconstruction of the canal wall, for pediatric cholesteatoma.MethodsWe retrospectively evaluated a series of 25 consecutive ears of 24 patients who were ≤16 years of age. All children underwent cholesteatoma surgery between October 2002 and August 2008. The type of cholesteatoma, the length of follow-up, the incidence of residual and recurrent cholesteatoma, postoperative hearing results, and the form of the reconstructed external canal wall and tympanic membrane were assessed.ResultsThere were 21 males and 3 females. The procedure was performed on both ears of one patient who had bilateral congenital cholesteatoma (CC). At the initial surgery, 16 cases (64%) had CC and nine (36%) had acquired cholesteatoma (AC). The mean age at surgery was 8.2 years and 10.4 years for CC and AC cases, respectively. The mean postoperative follow-up period after the initial surgery was 90 months for CC cases and 108 months for AC cases. Cholesteatoma recurrence occurred for 6% and 56% of cases with CC and AC, respectively. Successful serviceable hearing was achieved for 93.8% with CC and 100% with AC. Cases with inadequate hearing after surgery were characterized by disease extension to the mastoid and the protympanum. The long-term forms of the reconstructed external canal wall changed depending on their middle ear aeration. Some cases of tympanic membrane perforation and otitis media with effusion were occurred during the follow-up period.ConclusionOverall, the retrograde approach with soft-wall reconstruction of the canal wall achieved a low recurrence rate for cholesteatoma and good hearing outcomes during long-term follow-up for the pediatric case. However, in cases with eustachian tube dysfunction and/or cholesteatoma involving the protympanum, the hearing outcomes were less favorable.     

Mastoid obliteration combined with soft-wall reconstruction of posterior ear canal

To clarify the usefulness of modified soft-wall reconstruction method by combing with mastoid obliteration, 96 patients (98 ears) with their age ranging from 5 to 82 (average 51.3), including 62 ears with chronic otitis media (COM) with cholesteatoma, 18 ears with non-cholesteatomatous COM, 14 ears with postoperative cavity problem, and 4 ears with adhesive-type COM, who had soft-wall reconstruction of the posterior ear canal and mastoid obliteration using mainly bone powder following mastoidectomy, were evaluated their postoperative conditions more than a year after surgery. Overall success rate was 76.5% (75/98), and fresh cases showed better success rate (84.8%) than those with a history of multiple surgeries (69.2%). Among unsuccessful cases, crust and/or debris accumulation was observed most (nine ears), followed by persistent wet condition (seven ears), and exposure of the obliterated material (five ears), while only two ears showed a retraction pocket formation. The success rates remained almost the same among those who were followed for more than 2 and 3 years (46/61, 75% and 21/28, 75%, respectively). In 60 ears on which postoperative hearing was assessed, 41.7% showed less than 15 dB of air-bone gap (ABG), and 61.7% showed less than 20 dB of ABG. Mastoid obliteration with bone powder in combination with soft-wall reconstruction of the posterior ear canal appeared a useful method for obliterating mastoidectomized cavity especially for prevention of postoperative pocket formation. This paper was presented at the 139th Annual meeting of American Otological Society, in Chicago, IL, USA on May 20, 2006, and its abstract appeared in the Transactions of the American Otological Society, Inc.