慢性化脓性中耳炎完壁式乳突切开加鼓室成形术中开放上鼓室前气房26例疗效分析

Curative effect analysis of closed mastoidectomy+tympanoplasty+opening epitympanic anterior recess in 26 cases of chronic suppurative otitis media

[背景]观察慢性化脓性中耳炎完壁式乳突切开、鼓室成形术加上鼓室前气房开放建立新引流通道的临床疗效.[病例报告]选择慢性化脓性中耳炎静止期患者26例,其中3例为双耳患病,共计29耳.所有患耳均施行完壁式乳突切开、鼓室成形术加上鼓室前气房开放术,均未施行面神经隐窝开放术.术后1~3年（平均23个月）进行了随访听力、并发症、上鼓室前气房分型调查.29耳均获治愈,无1例复发.气导听力由术前的（42.0±16.0）dB HL降低为术后的（27.0±15.6）dB HL,相比较差异有统计学意义（P〈0.01）,骨导听力由术前的（25.0±11.8）dB HL降低为术后的（14.0±7.6）dB HL,相比较差异有统计学意义（P〈0.05）.上鼓室前气房分型结果为中板状型19耳（65.5%）,锥体型7耳（24.1%）,前型3耳（10.3%）.[讨论]慢性化脓性中耳炎手术过程中鼓室前气房开放是重要的引流通道之一.

BACKGROUND To observe the clinical curative effects of closed mastoidectomy ＋tympanoplasty＋opening epitympanic anterior recess to establish a new drainage channel for chronic suppurative otitis media（CSOM）.CASE REPORTS 26 patients with CSOM in stationary phase were selected,in witch 3cases of binaural CSOM,29 ears in total.All of 29 ears were operated by way of closed mastoidectomy＋tympanoplasty＋opening epitympanic anterior recess with no facial nerve recess open surgery.It was followed up to survey in 1-3years later（mean of 23months）after operation that the hearing,complications and types of epitympanic anterior recess.All of the 26 cases with CSOM were cured with no relapse,and the air conduction and bone conduction hearing had significant differences（42.0±16.0）dB HL preoperation than（27.0±15.6）dB HL postoperation（P〈0.01）,（25.0±11.8）dB HL preoperation than（14.0±7.6）dB HL postoperation（P〈0.05）,respectively.Types of epitympanic anterior recess was plate type in 19ears（65.5%）,cone type in 7ears（24.1%）and antetype type in 3ears（10.3%）.DISCUSSIONThe way of opening epitympanic anterior recess is one of the most important way of drainage channels in CSOM.