鼓室硬化的手术疗效观察

Observation of tympanosclerosis operation result

目的：观察鼓室硬化手术采用综合技术的疗效。方法：回顾性分析151例（167耳）鼓室硬化（不含单纯鼓膜钙化）患者的临床资料。167耳均清除病灶并按需采用综合技术：①探孔开放上鼓室、乳突腔等；②自体骨片盾板修复，或碎骨填塞乳突腔；③听骨处理分为保持听骨链完整和听骨链重建；④可吸收膜片（透明质酸或聚二氧杂环乙酮）防再粘连；⑤鼓索神经弹压听骨；⑥铒-YAG激光或小凿清除面神经管骨质增生。术后1个月内测听力，出院3个月后复查1次，以后6个月～1年随访1次，以最后1次为随访结果（取0．5、1．0、2．0kHz HL语频均数）。结果：167耳术前、术后气骨导差（ABG）分别为（39．74±12．54）dB和（20．68±11．80）dB，P〈0．01。成功71耳（42．5％），有效48耳（28．7％），总有效率为71．3％（119耳）。167耳随访3～60个月，平均（11．01±10．24）个月，随访的ABG为（20．67±13．52）dB，与术前比较，P〈0．01；与术后比较，P〉0．05。随访12个月以上者96耳，ABG为（21．94±11．16）dB，与167耳随访结果比较，P〉0．05。结论：应用综合技术能促进术后听力改善，并维持远期疗效。三骨全固定仍是治疗难点，对镫骨切除术应慎重对待。

Objective： To assess effects of multi-technique operation for tympanosclerosis. Method： A retrospective analysis of 157 cases （167 ears）of tympanosclerosis（the cases with only tympanic membrane calcification were excluded）was undertaken. All patients received the multi- technique if needed： ①Open the attic, mastoid antrum etc; ②Rebuild scute with auto-bone or infill the mastoid cavity with auto bone pieces;③Preserve or reconstruct the ossicular chain;④Utilize the absorbable Merogel to prevent re-adhering;⑤Press prostheses with tympanic chorda nerve as a spring;⑥Clear out hyperplastic bone on facial canal with Er-laser or small chisel. Postoperative audiometric measurements were undertaken within one month. And the follow up audiometric measurements were performed at three months after surgery, and then every half or one year later again. The last evaluationes were considered as the results of follow up（takinge the average hearing threshold at 0.5,1.0,2.0 kHz HL）. Result：The mean air-bone gap （ABG） of 167 ears was （39. 74±12.54）dB before operation, while it was elevated to（20. 68±11.80）dB after operation（ P 〈0.01）. Surgical treatment was found to be successful in seventy-one ears （42.5%） and effective in forty-eight ears （28.7%）. The total effectiveness was 71.3% （119 ears）. Followup result was （20.67±13. 52）dB, compare with pre-operative hearing threshold （P 〈0. 01）. However, it had no difference comparing with post-operative hearing threshold （P 〉0.05）. Of 96 ears which were followed up over 1 year, the average ABG was （21. 94±11.16）dB comparing with that of the total 167 ears follow up result （P 〉 0.05）. Conclusion： Using multi-technique can obtain better and consistent hearing results. Surgery for total ossicular chain fixation of tympanosclerosis is still difficult. Stapedectomy still needs to apply in tympanosclerosies cautiously.