上鼓室胆脂瘤与听骨链重建术

目的 :探讨上鼓室胆脂瘤患者在凿开上鼓室 ,清除胆脂瘤组织后重建上鼓室壁并一期听骨链恢复传音功能的方法和效果。方法 :对上鼓室胆脂瘤 2 3例行上鼓室凿开术 ,清除胆脂瘤上皮组织 ;酌情剪除锤骨头 ,取出砧骨体 ,然后行镫骨头上加高或锤骨长柄、镫骨头连接术。观察术后鼓膜愈合及听力恢复情况。结果 :随访 2 3例 4～ 1 2年 ,2 0例鼓膜愈合良好 ,2例鼓膜后上方外移 ,1例鼓膜发生 2mm穿孔并且胆脂瘤复发。术后气骨导差值 <1 0dB 8例 ,<2 0dB 6例 ,<3 0dB 6例 ,3 0dB以上 3例。以镫骨头上加高听力恢复最好。结论 :上鼓室胆脂瘤患者应以清除胆脂瘤上皮为前提 ,清除病变后根据情况重建上鼓室壁和听骨链 ,有助于恢复听力

Attic cholesteatoma and reconstruction of auditory ossicular chain

Objective:To study the manner and evaluate the efficacy of atticotomy with one-step reconstruction of auditory ossicular chain so as to not only clear cholesteaoma but also rebuilt the ossicular chain in the patients with attic cholesteatoma.Method:23 cases were performed atticotomy and different types of tympano-ossiculaplasty.When the incus was to be destroied,but malleus handle and stapes arch presented,the malleus to stapes assembly which employed a sculptured were used,fitted incus prosthesis between the handle of the malleus and the head of the stapes.If the neck and head of the stapes were absent,the ossicular can be shaped in relation to the defect in such a way that contact between the stapedial remnant and the malleus would be stable.The patients with absence of the malleus required a columneller type (L-shapped bone) of ossiculoplasty to connect the graft with the steps.Result:The follow-up was from 4 to 12 years.The postoperative pure-tone average were compared with the preoperative levels.The postoperative air-bone gap within 10 dB was obtained in 8 cases,20 dB in 6 cases,30 dB in 6 cases.Only 3 cases'air-bone gaps were beyond 30dB and 2 cases suffered from the recurrent cholesteatoma.The L-shapped conductive system for absence of the malleus was less efficient than other types of reconstruction.Conclusion:The primary objective to treat the patients with attic cholesteatoma is total eradication of disease with a dry,safe ear;a concomitant but secondary objective is hearing retention and restoration with tympanoplasty.In the present study,the atticotomy with one-step tympano-ossiculaplasty procedure achieves a significant better hearing.