粘连性中耳炎手术疗效分析

Observation of adhering otitis media operation result

目的 分析观察多种措施治疗粘连性中耳炎的效果。方法 1999年 7月— 2 0 0 3年 12月间 ,对 2 13耳手术综合采取了盾板重建修复、自体骨制作臼柱或枪柱状听骨、鼓索神经弹压置入听骨、可吸收网片作隔离物预防再粘连等多种技术 ,并连续观察随访 ,对到 2 0 0 4年 5月 31日随访时间达到 12个月以上的 10 8例 (12 0耳 )进行疗效分析。其中男 4 5例 ,女 6 3例 ,双耳 12例。平均年龄 4 8 9岁。有胆脂瘤根治手术史 (根治后组 ) 2 0耳 ,并发胆脂瘤 (胆脂瘤组 )的 4 6耳 ,无胆脂瘤也没有根治史的粘连性中耳炎 (其他组 ) 5 4耳 ,其中包括合并钙化、骨化 6耳。结果 12 0耳术前平均气骨导差为(38 6 0± 12 70 )dB ,术后为 (15 2 8± 11 6 9)dB ,配对t检验 ,t=2 1 2 4 ,t0 0 1=2 6 0 <2 1 2 4 ,P <0 0 1。术后气骨导差小于 2 0dB的成功者为 84耳 (70 % ) ,小于 10dB接近闭合的最佳效果为 4 8耳 (40 % ) ,其中胆脂瘤组是 2 2耳 (48% ) ,根治后组是 5耳 (2 5 % ) ,其他组是 2 1耳 (39% )。术后气导听阈小于 4 0dB实用水平的是 83耳 (70 % ) ,术后气骨导差缩小达 30dB以上的显效者 33耳 (2 7 5 % )。术后气骨导差缩小大于 15dB或气导听阈小于 4 0dB的有效者为 10 5耳 (87 5 % )。气骨导差减小少于 10dB 。

Objective To assessment result with multi measures operation for adhering otitis media Methods A retrospective review of 108 cases (male 45, female 63),double ears 12, all was 120 ears Of 20 ears had been radical operated for chlosteatoma some years ago Of 46 ears had incorporate chlosteatoma now Of 54 ears had only adhering in middle ear but no had been radical or incorporate chlosteatoma who underwent operation from January 1999 to May 2003 for chronic ear disease as well as ossiculoplasty with multi technique measures(for example auto bone cup pole or gung pole as total and partial ossicular replacement prostheses; scute rebuild by auto bone; absorbable Merogel; tympanic chorda nerve as a spring press prostheses etc)were used in operation, and were followed up mean (26 11±11 31) months(rang 12～53 months) Results One hundred and twenty ears mean AB gap was (38 60±12 70) dB pre operation It was (15 28±11 69) dB post operation Partnership t test, t =21 24, t 0 01=2 60<21 24, P <0 01 The air bone gap (AB gap) closure to within 20 dB as succeed achieved in 70%(84 ears). AB gap closure in 10 dB as best result in 40%(48 ears) Air conduction was under 40 dB in 70% (83 ears) AB gap closure not enough 10 dB and Air conduction over 40 dB as no effect was 6% (7 ears) Conclusions As long as technique measures is right, even though adhering middle ear had much difficult in operation,it still can gain succeed to 70% But had still 30% no succeed, more study is necessary