摘要
【目的】探讨少年儿童中耳胆脂瘤手术的疗效以及采用"完壁法"的优点。方法25例。男18例,女7例。平均年龄15.74±3.97岁(范围4-19岁),随访66.75±38.32月(范围12-132月)。13例一次手术。12例有再次手术,平均再手术次数是3次,共计手术49次。其中6例初次手术在本院(可追溯到8-16年前,4例是去壁法的开放的技术,2例采用完壁技术,因残留疾病如鼓膜穿孔,鼓室积液,胆脂瘤复发等再手术),19例本院初次手术中术前8例有1-12月以上流脓史,3例有紧张部穿孔,15例有松弛部袋凹或肉芽,1例鼓膜完好,有传导聋。另6例初次手术在外院,本次手术均有胆脂瘤复发。术前平均气骨导差(取0.5-2kHz均数,下同,37.16±15.52)dBHL,平均气导(46.45±17.45)dBHL,平均骨导(9.45±6.12)dBHL。完壁法技术包括:彻底清除胆脂瘤病灶"前后夹击法":前卸盾板、后探孔,保留与外耳道后壁延续的上鼓室与鼓窦间骨桥,胆脂瘤从桥下完整掏出。用"自体骨回复技术"把卸下的盾板、探孔的耳道成块骨质修磨成听骨(臼柱或枪柱),和修复耳道壁(包括盾板)骨片,尽可能保留乳突腔内黏膜,使鼓室乳突再气化,鼓索神经弹压听骨,置入防粘连可吸收网片或注入透明质酸胶液。带钢芯塑管探察咽鼓管,必要时(术前有鼓室积液)给予鼓膜置管等多项综合技术]。以往已作去壁法手术的患者用自体耳道或乳突骨片作壁修复。取最后一次随访听力为结果,统计分析采用U检验。结果本院首次手术后复发的6例再手术中发现都有胆脂瘤皮囊存在,并伴有深部和周围的骨质侵蚀。残留复发率6/19=31%(完壁法复发率2/15=13%)。再手术后随访都超过12月,没有再复发迹象。有3例随访CT显示中耳气化良好,毫无胆脂瘤复发征象。25例术后平均气骨差(15.95±12.99)dBHL,与术前相比,U值5.13>u0.01=2.57,P<0.01.差异有极显著性意义。术后均气导(28.41±14.43)dBHL,与术前相比,u值3.90>u0
Objective To report results of treatment ofotitis media with cholesteatoma using the canal-up technique in pediat- ric patients. Methods Twenty five patients （18 boys and 7 girls, mean age = 15.74±3.97 years ranging from 4 to 19 years）were in- cluded. Average follow up was 6.75±38.32 months （12 -132 months）. Thirteen patients received only one operation. Revision pro- cedures were performed in 12 patients （mean revision procedures = 3）, resulting in a total of 49 procedures. In 6 cases, the first oper- ation was performed in our hospital 8-16 years ago. Canal down technique was used in 4 of the 6 cases and canal up technique was used in,2 cases. Revision was needed,due to residual diseases including perforation of tympanic membrane, tympanic cavity effu- sion, and recmTence of cholesteatoma. Of the 19 cases in which the first operation was performed in our hospital, 8 presented with 1-12 months history of purulent drainage, 3 with pars tensa perforation, 15 with pars flaceida pockets or granulation, and 1 with in-tact tympanic membrane but conductive deafness. Canal down technique was used in the other 6 cases whose primary operation was performed by other hospitals, all with recurrence of cholesteatoma. Pre-operative average air-bone gap （GAP） over 0.5-2 kHz was 37.16± 15.52 dB HL in 25 cases and mean air and bone conduction （AC and BC）thresholds were 46.45± 17.45 dB HL and 9.45 ±6.12 dB HL respectively. Surgical treatments included eradication of cholesteatoma using a canal-up technique, with the bony bridge or posterior canal wall preserved. The mucosa in mastoid cavity was preserved for possible re-pneumatization. The tympani corda was preserved to support the POPE or TOPE. A tube was left in place in cases with pre-operative tympani cavity effusion. The U test was used in outcomes assessment. Results Drum perforation, effusion and recurrent cholesteatoma were seen during revision in the 6 cases originally operated in our hospital, with cholesteatoma pockets and bone erosion. The recu
出处
《中华耳科学杂志》
CSCD
北大核心
2013年第2期263-266,共4页
Chinese Journal of Otology
基金
上海市卫生局科研基金资助
编号:09-227
关键词
少年儿童
中耳炎
胆脂瘤
鼓室成形
听力重建
完壁法
去壁法
Juvenile and Children,otitis media, cholesteatoma, tympanoplasty, haering reconstruction, canal -up, canal-down
