完壁式乳突根治术并鼓室成形术治疗中耳炎效果观察

Clinical Effect Observation of Canal Wall up(CWU) Type Radical Mastoidectomy Combined with Tympanoplasty for Treatment of Otitis Media

目的探讨完壁式乳突根治并鼓室成形术治疗慢性化脓性中耳炎的手术方法、注意事项及疗效。方法选取2011年5月—2012年2月该院住院的84例（92耳）病人作为治疗组,实施完壁式乳突根治并鼓室成形术。术后观察病人情况,随访6个月-1年。结果术后1年,测患者听力,听力提高30 dB的为14例,占16.7%。提高20 dB的40例占47.6%。提高15 dB的24例占28.6%,术后听力改善率为93.2%（78/84）,听力无改善率7.14%（6/84）。92耳切口均I期愈合,干耳时间为1-3个月。干耳时间平均8周。继发性感染2例,复发1例,并发症及复发率为3.6%。结论完璧式乳突根治术并鼓室成形术符合清除病灶并保存听力的耳外科原则。对于慢性中耳乳突炎具有良好的治疗效果,可以有效保留原中耳乳突解剖结构和改善听力,提高患者生活质量,应予优先选择。

Objective To discuss the surgical method, attentions and clinical effect of CWU radical mastoidectomy combined with tympanoplasty for treatment of chronic suppurative otitis media（CSOM）. Methods 84 patients（92 ears） hospitalized in our hospital during May, 2011 to February, 2012 were chosen as treatment group and given CWU radical mastoidectomy combined with tympanoplasty. All patients were given 6 months to 1 year follow-up visits after surgeries. Results 1 year after surgery, the hearing of the patients was measured. 14 patients got a hearing increase of 30 dB, accounted for 16.7%; 40 patients got a hearing increase of20 dB, accounted for 47.6%; 24 patients got a hearing increase of 15 dB, accounted for 28.6%. After surgery, hearing improvement rate was 93.2%（78/84） and hearing without improvement rate was 7.14%（6/84）. Incisions of 92 ears all reached Ⅰ healing. Dry ear time was 1 to 3 months and average dry ear time was 8 weeks. There were 2 cases with secondary infection and 1 case with relapse, complication and relapse rate was 3.6%. Conclusion CWU radical mastoidectomy combined with tympanoplasty conforms to the principle of ear surgery of elimination of focus and conservation of hearing. It has a good curative effect for chronic otitis media. It can effectively conserve anatomical structure of original mastoid of middle ear and improve hearing, enhance life quality of patients. And it should be selected preferentially.