硬质耳内镜在胆脂瘤中耳炎手术治疗中的应用

Application of otoendoscopy in the surgery for middle ear cholesteatoma

目的探讨耳内镜在胆脂瘤中耳炎手术治疗中的作用。方法2003—2005年的中耳胆脂瘤患者43例43耳,应用硬性耳内镜协助下行乳突根治+Ⅰ期鼓室成形术,并在耳内镜下随访2年以上(平均2.211±0.323年)。结果术后1.5～3月干耳40例,鼓膜色泽正常。2例内陷袋形成,术后1年经耳内镜手术探查,发现为中耳粘连导致上中鼓室通气不畅。1例术后0.5年因患耳流脓再次手术,为修补之鼓膜与鼓窦口上皮粘连,后鼓室有孤立胆固醇肉芽肿,清除粘连及病变组织后2月干耳。随访测听结果:听力提高10～20dB21耳,21～30dB15耳,>30dB4耳,<10dB3耳。结论耳内镜能够弥补耳显微镜的不足,辅助清除中耳病灶以增加手术成功率。

Objective To evaluate the effect of otoendoscopy on middle ear cholesteatoma surgery. Methods From 2003 to 2005 otoendoscope-assisted mastoidectomy and tympanoplasty was performed for 43 patients suffered from middle ear cholesteatoma, all cases received a regular follow-up for at least 2 years. Results Forty cases achieved a dry ear successfully 1.5 months to 3 months after operation. Two cases developed retraction pockets caused by middle ear adhesion found by revision endoscopic operation 1 year after the first operation. Another case recurred half a year later and obtained a dry ear after a revision operation during which cholesterol granuloma was found in the posterior tympanum. Hearing was improved by 10 - 20 dB in 21 cases, by 21 - 30 dB in 15 cases, by more than 30 dB in 4 cases, and only 3 cases improved by 10 dB or less. Conclusion Otoendoscopy can assist the surgeon in performing microscopic ear surgery and increase the success rate.