上鼓室胆脂瘤型中耳炎的手术治疗

目的探讨上鼓室胆脂瘤型中耳炎的手术治疗方法。方法对23例（23耳）上鼓室胆脂瘤型中耳炎患者经耳内切口行上鼓室切开清理病变。20耳胆脂瘤破坏并超过锤砧关节达前上鼓室，3耳锤砧关节鼓室侧隐藏胆脂瘤，彻底清除胆脂瘤并切除病变的锤骨头及砧骨，人工听小骨（partial ossicular replacement protheses，PORP）架桥于锤骨柄与镫骨头之间重建听骨链（Ⅲ型鼓室成型术）。23耳采用带软骨膜的耳屏软骨重建上鼓室外侧壁，其软骨膜修复鼓膜松弛部穿孔。观察术后上鼓室外侧壁和鼓膜愈合及听力恢复情况。结果23例患者随诊1～4年，所有病例上鼓室外侧壁及鼓膜松弛部愈合良好。术后患耳PTA=21．1 dB HL，较术前平均降低12．8 dB HL，差别有统计学意义（t=20．136，P〈0-01）；术后患耳气骨导差下降12．8 dB HL，差别有统计学意义（t=19．48，P〈0．01）；术后患耳骨导听阈改变无显著意义（t=1．56。P〉0．05）。一例患耳术后出现4000Hz以上感音神经性听力下降。术后随访听力基本稳定，无眩晕及耳鸣等并发症。结论上鼓室胆脂瘤型中耳炎应尽早发现，合理的手术方式既可彻底清除病灶。又能保留和恢复中耳传音功能。

The surgical treatment of epitympanic cholesteatoma

Objective To explore the surgical treatment for epitympanic cholesteatoma. Methods Twenty-three patients （23 ears） of epitympanic cholesteatoma received atticotomy to remove lesions via endaural incision. In 20 ears, cholesteatoma extended beyond the malleo-incudal joint and destroyed it .In 3 ears, cholesteatoma located behind the joint reaching the surface of epitympany. The head of malleus and incus were removed during the operations in all cases. The reconstruction of the ossicular chain was performed by putting PORP between the manubrium of malleus and the head of stape. In all 23 ears, the lateral wall of attic was reconstructed with tragus cartilage with perichondrium. The perichondrium was used to repair the perforation of the pars fiaccida of the tympanic membrane. The healing of the attic lateral wall and the tympanic membrane along with the hearing levels were observed after the operation. Results The cases were followed up from 1 to 4 years. The healing of the attic lateral wall and the tympanic membrane were satisfying in all cases. According to the pure-tone audiometry, the average PTA threshold was 21.1 dB HL, decreased 12.8 dB HL in average after the operation. The A-B gap decreased of 12.8 dB HL. All these differences were statistically significant. The thresholds of bone conduction audiometry had no significant changes. One case was found to have sensorineural hearing loss above 4000 Hz after the operation. No vertigo or tinnitus occurred after the operation in all cases. Conclusion Not only can early detection and appropriate surgical treatment remove cholesteatoma completely, but also reserve and restore the acoustic transmission function of middle ears.