完壁式乳突根治鼓室成形术治疗胆脂瘤中耳炎

Intact canal wall mastoidectomy and tympanoplasty in treating patients with cholesteatoma of the middle ear and mastoid

目的：探讨完壁式乳突根治鼓室成形术治疗胆脂瘤中耳炎的临床效果和相关的经验教训。方法：对57例胆脂瘤中耳炎患者实施完壁式乳突根治鼓室成形术。结果：随访1～8年，平均3．7年。术后5例感染流脓，其中3例经及时处理得到控制并愈合，2例二次手术处理后愈合；3例术后因胆脂瘤复发行开放式乳突手术获干耳；鼓膜完整但有内陷者29例，其中2级内陷者13例；术后8个月及1年人工听骨脱出各1例。术后言语频率气导听阈降低〉10dB HL为72．2％（39／54），气骨导差〈20dB HL为53．7％（29／54），气骨导差缩小25dB HL以上占42．6%（23／54）。结论：施行完壁式乳突根治鼓室成形术，如果适应证掌握得当，技术条件许可，患者能按时随访，可以有效保留原中耳乳突解剖结构和改善听力，提高患者生活质量，应予优先选择该术式。

Objective：To evaluate the value of intact canal wall mastoidectmy and tympanoplasty in treating patients with cholesteatoma of the middle ear and mastoid. Method：Fifty-seven patients underwent intact canal wall mastoidectmy and tympanoplasty. Result：In all cases who had been followed up for 1-8 years, 5 ears were infected,2 patients needed second operation, and 3 ears suffered from cholesteatoma recurrence. Tympanic membrane of 29 ears kept integrity although with pocket retraction to some extent. Extrusion of the prosthesis occurred in 2 cases. The postoperative audiometric measurement （ the average hearing threshold at 0.5, 1.0,2.0 kHz HL） was improved by more than 10 dB HL in 39 ears （72.2%）, the mean air bone gap （ABG） of 29 ears was reduced to less than 20 dB HL. Conclusion： Intact canal wall technique could remain anatomical structure and improve hearing effectually in treating the patients with cholesteatoma in the middle ear and mastoid.