论文部分内容阅读
目的探讨胆脂瘤中耳乳突炎的手术策略及术式选择,比较远期效果与生活质量。方法回顾性分析1994至2003年随访3年以上的266例(269耳)经手术治疗的胆脂瘤中耳炎病例的临床资料及随访结果,比较切除外耳道后壁的乳突鼓室成形术(canal wall down,CWD)、保留外耳道后壁的乳突鼓室成形术(canal wall up,CWU)与改良的保留骨桥的乳突鼓室成形术(intact-bridgetympanomastoidectomy,IBM)三种常用术式的特点及远期效果。结果对各组干耳时间、语言频率气导听阈与气骨导差缩小程度进行比较。各组听力提高幅度及气骨导差缩小程度比较,CWU 组的效果与 CWD 组差异无统计学意义(F=3.686,P>0.05),而改良 IBM 组优于 CWD 与 CWU 组(F=125.167和59.438,P 值均<0.05)。在一次或分期手术的病例中,CWU 与 IBM 的干耳时间[分别为(6.0±1.6)周和(5.0±1.9)周]较 CWD 组[为(9.0±2.8)周]缩短(F 值为56.327和30.639,P 值均<0.05);CWU 组(24.6%)术后复发率高于其他2组(CWD 组为6.0%,IBM 组为7.0%。x请下载后查看，本文暂不支持在线获取查看简介。2值为6.162和6.007,P 值均<0.05)。结论根据胆脂瘤病变范围选择不同术式仍是外科治疗的原则,手术通常以 CWU 开始,根据术中所见决定开放范围。改良 IBM 因其良好的暴露,以及保留低位骨桥等处理,胆脂瘤病灶清除彻底。鼓室骨性外壁完整,可最大限度维持中耳腔容积,干耳率与听力改善等远期效果优于其他术式。
Objective To investigate the surgical strategy and operative choice of cholesteatoma otitis media with otolaryngitis and to compare the long-term effect and quality of life. Methods The clinical data and follow-up results of 266 cases (269 ears) of cholesteatoma otitis media surgically treated from 1994 to 2003 with a follow-up of more than 3 years were retrospectively analyzed. The canal wall down , CWD), the characteristics and long-term follow-up of three commonly used surgical procedures to preserve the canal wall up (CWU) of the posterior wall of the external auditory canal and the modified intact-bridge tympanomastoidectomy (IBM) effect. Results The duration of dry ear, frequency of hearing threshold of air conduction and the degree of reduction of air conduction were compared. Compared with CWD group, the effect of CWU group was not statistically significant (F = 3.686, P> 0.05), while the improvement of IBM group was better than that of CWD and CWU group (F = 125.167 And 59.438, P <0.05). In one-time or staged surgery, CWU and IBM had shorter ear dry times (6.0 ± 1.6 weeks and 5.0 ± 1.9 weeks, respectively) than those in the CWD group (9.0 ± 2.8 weeks) (F 56.327 and 30.639, P <0.05). The recurrence rate in CWU group (24.6%) was higher than that in other two groups (6.0% in CWD group and 7.0% in IBM group. View for access .2 values were 6.162 and 6.007, P values were <0.05). Conclusions Choosing different surgical procedures according to the range of cholesteatoma lesions is still the principle of surgical treatment. The procedure usually starts with CWU, and according to the intraoperative findings, it is decided to open the scope. Improved IBM due to its good exposure, and the preservation of low bone bridge and other treatment, clear removal of cholesteatoma complete. The tympanic osseous wall is intact, which can maintain the volume of the middle ear cavity to a maximum extent. The long-term effect of dry ear rate and hearing improvement is superior to other surgical procedures.