中耳乳突根治手术后鼓室病灶清理治疗方法的探讨

Discussion on the treatment method for cleaning the posterior tympanic lesions in radical mastoidectomy of middle ear

目的探讨中耳乳突根治手术开放并清理后鼓室病灶的体会。方法对2008—04—2011—04西安交通大学第一附属医院耳鼻咽喉一头颈外科收治并完成中耳乳突根治手术的125例慢性中耳炎患者进行回顾性分析，其中48例行完璧式乳突根治术＋鼓室成形术，77例行开放性乳突根治＋鼓室成形术，术中均仔细探查并清理后鼓室炎性病变，去除不可逆病灶，同期行鼓室成形术，手术后定期换药直至干耳。结果术后随访12—24个月，125例患者中121例获得干耳，4例炎症复发或未干耳，干耳率达96．8％。65例患者鼓室成形术后平均听力提高〉15dB，占所有患者的52．0％。结论中耳乳突根治手术中，行后鼓室入路探查和清理病变较为可行而且视野较广阔，对提高手术疗效，防止炎症复发有重要的意义。

Objective To disscuss the treatment method for cleaning the inflammatory spot of the posterior tympanic cavity in radical mastoidectomy operation. Methods The clinical data of 125 cases undergoing radical mastoidectomy of middle ear were retrospectivelyanalyzed in department of otorhinolaryngology-head and neck surgery of First Affiliated Hospital of Xi＇ an Jiaotong University from April 2008 to April 2011. Of 125 cases ,48 cases underwent the＂ closed wall＂ radical mastoidectomy and tympanoplasty, and 77 cases under- went the＂ opened wall＂ radical mastoidectomy ＋ tympanoplasty. During the operation, the posterior tympanic cavity were carefully probed and the inflammatory spots were completely removed combined with the tympanoplasty, and the postoperative ear dressing process was held regularly till the＂dry ear＂ standard. Results After 12 -24 months postoperative follow-up, 121 cases reached the ＂dry ear＂ standard ,4 cases recurred or did not reach the ＂dry ear＂ standard. The total ＂dry ear＂ rate was 96.8%. The average hearing threshold improvement in 65 of 125 cases was higher than 〉 15 dB, and the improvement rate was 52.0%. Conclusion During the operation of radical mastoidectomy, the approach via posterior tympanic cavity to probe and clean the inflammation spots is practical and of broad visual field. It is of high significance in improving the clinical effect and preventing the recurrence of the middle ear imflammatory spot.