Tos改良联合进路鼓室成形术短期疗效观察

目的：观察Tos改良联合进路鼓室成形术治疗慢性化脓性中耳炎的短期疗效。方法：回顾性分析26例（28耳）施行改良联合进路鼓室成形术病例,总结技术特点,观察手术并发症及术后听力。结果：26耳（92.86%）干耳;3耳术后鼓膜再穿孔（10.71%）,其中2耳微小穿孔经处理后愈合。24耳术后3-6个月鼓膜恢复光锥,其中22耳保持鼓膜前倾角,1耳鼓膜-外耳道前壁夹角变钝,1耳鼓膜外移愈合。1耳再发性上鼓室内陷囊袋形成,1耳胆脂瘤复发。无听力下降、面瘫病例。手术前后纯音测听结果比较示：术后听阈（42.80±17.97）dB]优于术前（47.49±18.01）dB],差异有统计学意义（P〈0.05）,术后气骨导差（19.76±7.49）dB]较术前（30.65±10.02）dB]显著缩小（P〈0.01）。结论：改良联合进路鼓室成形术能有效清除鼓室及乳突病灶,并形成稳定的中耳含气腔和传声结构,适用于慢性化脓性中耳炎,尤其是气化不良乳突的完壁式乳突切除鼓室成形术。

Assessment of short-term results of Tos modified combined approach tympanoplasty

Objective：To observe the short-term results of Tos modified combined approach tympanoplasty（MCAT）in chronic suppurative otitis media.Method：This study is an observational study.The data of 26patients（28ears）underwent MCAT were collected.The surgical techniques,complications and preoperative and postoperative air-bone gap（ABG）were analyzed.Result：Of 28ears,26ears（92.86%）get dry after surgery.3ears（10.71%）repaired tympanic membranes and reperforate postoperatively in which 2 minimal perforations were cured to close up patient treatment.One ear develops posterosuperior retraction pocket and one ear re-occurs cholesteatoma.One ear occurs blunting in the anterior sulcus and one ear has lateralization of the tympanic membrane.There are no hearing worsen and facial nerve palsy.For hearing,the postoperative pure tone threshold is better than preoperation（42.8±17.97vs 47.49±18.01,P〈0.05）and postoperative ABG shrinks significantly（19.76±7.49vs 30.65±10.02,P〈0.01）.Conclusion：Based on the short-term results,Tos′MCAT can successfully dissect the diseases of tympanic cavity and mastoid and develop a stable aerating middle ear with a complete hearing conduction.It is safe and feasible in the treatment of chronic suppurative otitis media,as well as in the poor-pneumatic mastoid.