摘要
目的探讨慢性化脓性中耳炎鼓室成形术的可行性和疗效。方法对33例单侧慢性化脓性中耳炎患者在恢复咽鼓管功能、清除病变的同时行鼓室成形术，随访观察近期及远期疗效。结果33例患者中，3例术腔填塞时有耳鸣，取出填塞物后即恢复正常。术后2周去除外耳道填塞物后，27例移植片色泽正常，生长好，4例血液供应稍差，2例移植片下缘有裂隙，经对症处理后，移植物全部存活。随访至术后1年，鼓膜生长良好28例，占85％；2例半年后再发生鼓膜穿孔，但鼓室内干燥；1例移植的鼓膜穿孔后再流脓；1例移植物内陷，经咽鼓管吹张后好转；1例鼓膜内陷较明显，听力无改善。术后1年纯音测听语频区气骨导差较术前平均缩小10dB者9例，占27％；缩小15—20dB者14例，占42％；缩小25～30dB者6例，占18％；无变化4例，占12％。结论慢性化脓性中耳炎可行鼓室成形术。彻底清除病变，恢复中耳通气功能，加强抗感染，正确放置移植物并防止其感染；避免不愈合及胆脂瘤形成，是手术成功的关键。
Objective To discuss the feasibility and curative effect of tympanoplasty for chronic suppurative otitis media. Methods Thirty-three cases of chronic suppurative otitis media in the period of infection had infected tissue removed and the Eustachian tube restored during tympanoplasty. The short-and long-term curative effects were observed by follow-up visit. Results Among the 33 cases, 3 cases are found tinnitus during tamponading the cavity during operation and normal state resumeed after the tampons were taken out. 2 weeks after operation, tampons were taken out of the acoustic duct and the transplants in 27cases showed normal color and growth. 4 cases had low Bloodsupply. 2 cases showed bottom margin crevices. All the transplants were maintained after therapy. The follow-up showed that the tympanums in 28 cases grew we11（85% ）. Perforation of ear drum recurred in 2 cases 6 months afterwards. 1 case with the transplanted tympanum perforated and suppurated again. The transplant invaginated in 1 case but get better after inflating the eustachian tube. 1 case had relative severe tympanum invaginating and didn＇t show acoustic sensibility recovery. 1 year after operation, the tympanic membranes of 28 ears were normal. Among 33 cases, the air bone gap in 9 patients was improved 10dB HL. 14 ears were improved from 15 to 20 dB HL, 6 ears were improved from 25 to 30 dB HL. 4 cases showed no change. Conclusion Tympanoplasty can be performed in patients with chronic suppurative otitis media in the period of infection. The complete removal of diseased tissue, placing the transplant precisely, preventing formation of cholesteatoma and restoring the eustachian tube function are key factors to successful operation
出处
《中国医药》
2009年第9期720-721,共2页
China Medicine
关键词
化脓性中耳炎
鼓室成形术
Suppurative otitis media
Tympanoplasty
