新疆地区66例中耳胆脂瘤手术治疗的临床分析

Surgical Treatment Outcomes in 66 Cases of Middle Ear Cholesteatoma in Xinjiang

目的探讨新疆地区中耳胆脂瘤手术临床效果和相关的经验教训。方法对66例中耳胆脂瘤患者实施完壁式乳突根治或同时鼓室成形术和开放式乳突根治术并进行随访,观察其干耳恢复状况、并发症、复发情况以及术后听力改善程度。结果维吾尔族患者居多,近50%,19例行完壁式乳突根治术,47例行开放式乳突根治术;2例完壁式乳突根治患者术后半年复发(3.03%),第二次行开放式手术;其余均获得干耳;完壁式乳突根治术后言语频率平均听阈提高>25d B 16耳(24.24%),>15d B 7耳(10.61%),开放式手术听力提高>15d B 2耳(3.03%),术前和术后言语频率平均听阈差异分析有统计学意义(p<0.001)。结论完壁式鼓室成形术,如果适应证掌握得当,技术条件许可,可以有效保留原中耳乳突解剖结构和改善听力,应予优先选择,病变范围广泛无法施行鼓室成形术者应选择开放性手术。

Objective Report outcomes of surgical treatment for middle ear cholesteatoma operations in Xinjiang. Methods Sixty cases of middle ear cholesteatoma treated with canal wall up or canal wall down mastoidectomy with or without tympanoplasty were followed up, and treatment outcomes including achievement of dry ear, complications, recurrence and hearing improvement were reported. Results Nineteen cases received canal wall up mastoidectomy and 47 cases received ca？nal wall down mastoidectomy. Recurrence occurred in 2 cases （3.03%） receiving canal wall up mastoidectomy, which led to re？vision canal wall down mastoidectomy. All the other cases achieved a dry ear. For cases receiving canal wall up mastoidecto？my, hearing improved more than 25 dB in 16 ears （24.24%） and 15 dB in 7 ears （10.61%）;while for those receiving canal wall down mastoidectomy, only 2 ears （3.03%） achieved hearing improvement of more than 1 5dB （p〈0.001）. Conclusion With proper indications and adequate techniques, canal wall up mastoidectomy should be the treatment of choice, as it saves ana？tomical structures of the middle ear and mastoid and yields improved hearing outcomes. For cases with extensive lesions and no possibilities of tympanoplasty, canal wall down mastoidectomy should be performed.