乳突鼓室成形手术的分期问题

目的探讨分期乳突鼓室成形术在以提高听力为目的的功能性耳显微外科中的作用.方法本文总结了海军总医院1993-2003年3月2700例各类中耳手术中分期鼓室成形术102例,随访1～5年,手术主要类型为保留外耳道后壁的乳突切开鼓室成形术、切除外耳道后壁的乳突切开鼓室成形术,保留骨桥的乳突切开鼓室成形术,文中对分期手术的理念、适应症选择、手术方式选择及移植筋膜感染、不愈合等问题进行了分析.结果 102例分期手术中,85例(83.3%)愈合良好,其中7例一期术后干耳,但二期手术中发现后鼓室及鼓窦处胆脂瘤珠及肉芽组织;17例存在不同程度的问题,出现率16%,包括一期术后出现移7植物穿孔或延迟愈合,在后鼓室、鼓窦、面神经隐窝等处发现胆脂瘤肉芽组织,但鼓室粘膜有不同程度的修复.102例分期手术术后1年气导听力(O.5K、1k、2k平均听力)较术前提高15 dBHL.结论在彻底清除病灶基础上,合理而有计划的行分期手术修复鼓室粘膜,恢复中耳含气空腔,为听骨链重建创造条件,以提高听力,不失为较佳的选择.

Staging surgery for mastoidectomy with tympanoplasty

Objective To discuss the effectiveness of staged mastoidectomy with tympanoplasty in the ear micro-surgery for the purpose of improving hearing. Methods The results of 102 staged procedures from all kind of 2700 cases of middle ear surgery performed from 1993 to 2003 ,followed up 1-5 years,in the Departmant of Otolaryngology, Navy General Hospital are reported. The main kind of surgery included the canal wall up mastoidectomy with tympanoplasty ?the canal wall down mastoidectomy with tympanoplasty and intact-bridge mastoidectomy with tympanoplasty. The staging theory, indication, surgery peocedure and infection of the transplanted fascia were disused. Results In the 102 cases, 85 cases(83.3%) had a good result. In the second stage, it was found that there were cholesteatoma and residual disease in 7 cases which were cured in the first stage. Another 17cases have tympanic membrane perforation and delayed cure after the first stage. The cholesteatoma was found in the posterior tympanum, antrum and facial recess but the mucous membrane had some recovered. In 102cases,the hearing level has improved for 15 dBHL. Conclusion Staging of tympanoplasty is of an important technique in the effort of improving hearing level, that repairs mucous membrane and establishes an air-containing middle ear space on the base of eliminating disease.