胆脂瘤性中耳炎的手术方式选择(附860例临床分析)

Operative approach chosing to treat cholesteatoma otitis media(With clinical analysis of 860 cases)

：探讨提高手术治疗胆脂瘤性中耳炎疗效的方法。方法：对采用经上鼓室、经鼓窦筛区和完整外耳道－乳突联合进路手术清除病变，并同时一期完成鼓室成形手术的８６０例胆脂瘤性中耳炎病人的临床资料进行分析。结果：三种术式的复发率分别为１０％，１１％和６％；５年内听力提高分别为５６％，４４％和６９％，５～１５年内分别为４５％，３４％和６２％；鼓膜形态不同程度异常（内陷、粘连和穿孔）分别为４３％，４７％和１２％。结论：根据病变部位选择合适的术式虽都能起到根治、干耳作用，但完整外耳道－乳突联合进路术式优于前两者。

Objective:In order to improve operative effect to cholesteatoma otitis media. Method: The clinicaldata of 860 cases of patients with cholesteatoma otitis media were treated by surgery through three approachs(through epitympanum, cribriform area or combined approach ) were analyzed. Result: The results showed thatthe recurrent rates of them were 10%, 11 % and 6% respectively; The rates of improvement of hearing were56 %, 40 % and 69% five years after operation respcetively,and after 5 to 15 years were 45 %, 35 % and 62%; Therates of different abnormal shapes of tympanic membrane (including retraction,adherence and perforation) were43 %, 47 % and 12 %. Conclusion:According to the location of fool, we regard that various and appropriate operative approach should be selected to treat the cases with cholesteatoma otitis media,and the combined approachtympanoplasty has advantage over the other two.