闭合式乳突根治并鼓室成形术的临床研究

目的 探讨闭合式乳突根治并鼓室成形术的适应证及手术方法，以提高手术效果和患者的术后生活质量。方法总结了5年内采用闭合式乳突根治并鼓室成形术的术式49耳和开放式术式82耳的临床资料及随访结果。结果49耳行闭合式乳突根治术并鼓室成形术者术后20d全部干耳，听力提高在15dB以上者31耳，所有病例随访均无复发；82耳行开放式乳突根治术并鼓室成形术者术后20d干耳者仅13耳，无1耳听力提高在15dB以上者。虽然二者的疾病复发率差异无统计学意义，但前者术后恢复快，听力提高明显优于后者，并获得一个正常形态的外耳道，不需术后定期清痂换药。结论对于需行乳突根治术并鼓室成形术者，如果设备和技术条件具备，病变范围允许，应优先选择闭合式术式。

Clinical study of combined approach of tympanoplasty and mastoidectomy with close technique

OBJECTIVE: To improve the surgery results and living quality of patients following the operation of the combined approach of tympanoplasty and mastoidectomy with close technique. Methods The clinical data and following-up results of 49 patients treated with combined approach of tympanoplasty and mastoidectomy with close technique and 82 patients treated with open mastoidectomy with tympanoplasty were retrospective analyzed. RESULTS: In the group treated with combined approach tympanoplasty, all patients got dry ear in 20 days and 31 patients' hearing level enhanced over 15 dB after the operation; but in the group treated with open mastoidectomy with tympanoplasty, only 13 patients got dry ear in 20 days and no patients' hearing level enhance over 15 dB after the operation. Although the recurrence rates between two groups were not significant difference, the patients of former group not only took a shorter recovery time and got a better hearing recovery, but also kept a normal external auditory meatus, at the same time, they need not to clear scab at fixed period all life long. CONCLUSIONS: When performed on carefully selected patients, combined approach tympanoplasty was a feasible surgical method to improve the surgery results and living quality of patients following the operation, however, the advanced equipment and perfect operation skill are necessary.