慢性化脓性中耳炎鼓膜紧张部大穿孔手术方法的选择

The choice of surgical method for tympanic membrane perforation in Chronic suppurative otitis media

目的探讨慢性化脓性中耳炎鼓膜紧张部大穿孔手术方式选择的依据,明确乳突CT正常的患者进行乳突探查的必要性。方法病例材料来源于北京大学人民医院耳鼻咽喉科2014年至2015年收治的慢性化脓性中耳炎患者102例,所有患者均为鼓膜紧张部大穿孔,术前完善检查,102例患者中乳突CT异常的患者为85例(83.33%),乳突CT正常并且干耳2月以上患者17例(16.67%)。所有患者均全麻下进行乳突开放术及鼓室成形术。结果 102例患者术后随访鼓膜愈合均良好,乳突CT正常的患者在术中探查乳突、鼓窦、鼓室、听骨链、咽鼓管口区域,发现所有患者均存在一个及以上区域的病变,多处病变影响乳突鼓窦引流。结论乳突CT正常不能成为慢性化脓性中耳炎单纯鼓膜修补的标准,除外伤性鼓膜穿孔外均应进行乳突探查。

Objective To investigate the choice basis of surgical method for tympanic membrane perforation. To clear the necessity of mastoidectomy for the patient whose mastoid CT is normal. Methods 102 chronic otitis media patients underwent mastoidectomy and tympanoplasty from 2013 to 2015. All of the patients had a big perforation in the tympanic membrane tension department, perfect preoperative examination, 17 cases（16.67%） had normal mastoid CTs. Result The tympanic membrane graft take rate for the entire group of 102 patients was 100%. Made exploration in mastoid, tympanic antrum, tympanic cavity, auditory ossicle chain and eustachian tube area. Found that all of the 17 patients had lesions in more than one area. Conclusion Normal mastoid CT cannot be the standard of simply tympanoplasty in chronic suppurative otitis media, a mastoidectomy was needed if there was a big perforation in the tympanic membrane tension department,mucosa edema in tympanic cavity or inflammatory reaction in residual tympanic membrane.