胆脂瘤型骨疡型中耳乳突炎外科治疗的合理选择

Intact-bridge tympanomastoidectomy procedure:a reasonable option in the surgery of chronic otitis media and mastoiditis with cholesteatoma and/or granulation tissue

目的 探讨并评价胆脂瘤型 /骨疡型中耳乳突炎外科治疗的合理选择和术式改进。方法 对 6 1例 (6 2耳 )胆脂瘤型和 /或骨疡型中耳乳突炎住院病例施行完整骨桥式乳突手术 (intact bridgetympanomastoidectomy ,IBM) ,对原术式进行若干改进。开放上鼓室、鼓窦及乳突 ,切除骨性外耳道后壁、经面神经隐窝开放后鼓室。保留低位骨桥以维持中耳腔容积 ,去除不可逆病灶 ,同期或分期进行鼓室成形术。结果 随访 12～ 38个月 ,其中 5 1/ 6 2耳 (82 2 % )≥ 2年 ,干耳时间 5～ 13周 (平均 6周 )。术后纯音测听气骨导差 (air bonegap ,ABG)≤ 2 0dBHL 15 / 6 2耳 (2 4 2 % ) ,2 1～ 30dBHL2 6 / 6 2耳(41 9% ) ,≥ 31dBHL10 / 6 2耳 (16 1% )。结论 IBM手术将开放式与闭合式技术相结合 ,兼备二者的优点 ,符合清除病灶并保存听力的耳外科原则 。

Objective To study and evaluate a surgical option for the treatment of otitis media and mastoiditis with colesteatoma and/or granulation tissue Methods The procedure is called intact bridge tympanomastoidectomy (IBM). There are some modifications for the treatment of patients suffered from chronic otitis media and mastoiditis with colesteatoma and/or granulation tissue The features of IBM include: ① the aditus, mastoid and attic opened and the intractable pathological tissues eradicated thoroughly ② the posterior tympanal space opened through the facial recess if necessary ③ a widened middle ear space by lowing bony bridge established ④ the aditus blocked ⑤ immediate or staging tympanoplasties conducted according to the conditions of mucosa in the tympanum Results The modified IBM procedure was performed on 62 ears from 61 cases The follow up has been 12 38 months and more than two years in 51 ears The dry ear was obtained within 5 13 weeks with an average of 6 weeks In 24 2% of ears the air bone gap(ABG)was 20dB HL or less and within 21 30 dB HL in 41 9% of ears, the ABG over 31 dB HL was 16 1% Conclusion Our results indicate that IBM procedure fulfills the desired purposes of both open and close cavity techniques, the thorough eradication of diseased tissue allow to get a dry ear and restoration of hearing IBM, therefore, is a reasonable choice for the surgery of otitis media and mastoiditis with colesteatoma and/or granulation tissue