手术治疗儿童慢性化脓性中耳炎82例

目的探讨儿童慢性化脓性中耳炎（CSOM）的病变特点及手术方式的选择。方法在行手术治疗的儿童CSOM患者82例中，2例双耳病变者先行1耳手术，手术方式选择乳突根治术60例、改良乳突根治术20例、鼓室成形术2例。从术前并发症、病变范围、听骨破坏情况以及术后并发症等方面探讨其临床特征。结果82例手术中胆脂瘤型56例（68.2%），慢性化脓性中耳炎伴肉芽26例（31.7%），病变范围广泛，多累及外耳道鼓室、鼓窦、鼓窦入口，而听小骨破坏程度最重。术后随访0.5～2年，并发症出现有外耳道口狭窄8例，术腔增生挛缩8例；胆脂瘤复发1例，因术前病变严重术后面瘫未恢复1例。结论儿童CSOM其术前并发症中以颅外并发症多见，年龄越小病变程度越重，对其手术彻底清除病灶应放在首位，根据病变的情况选择不同的手术方式和主动定期随访可以有效降低术后复发率，经典的乳突根治术对儿童不宜采用。

Surgeries for 82 cases of chronic suppurative otitis media in children

To explore pathological changes of chronic suppurative otitis media(CSOM) of children so as to select a suitable operative method. MethodsOf the 82 cases, 60 cases were subjected to radical mastoidectomy, 20 cases modified radical mastoidectomy, and 2 cases tympanoplasty. ResultsAmong the 82 cases, 56 cases(68.2%) were cholesteatoma of the middle ear, and 26 cases(31.7%) were caries. Lesions involved into the acoustic duct, the cavum tympani,the tympanic sinus, the aditus ad antrum tympanicum, and the auditory ossicle, and the auditory ossicle was the most severly destroyed. Followed up from half a year to 2 years, stenosis at the door of the external auditory canal occurred in 8 cases, hyperplasia and contracture of the operative lacouna in 8 cases, relapse of the cholesteatoma in 1 case, and facial paralysis in 1 case. ConclusionExtracranial complications are frequent pre operative complications of CSOM in children, and the younger the patients, the severer the lesions. It is most important to thoroughly clear the focus of infection. Optional operative methods and regular follow up are helpful in decreasing relapse rate. Radical mastoidectomy is not suitable for CSOM in children.