改良完壁式鼓室成形术治疗上鼓室局限性阻塞性病变

Modified intact canal wall tympanoplasty for localized attic lesions

目的探讨上鼓室局限性阻塞性病变的手术方法与疗效。方法 75例(88耳)上鼓室局限性阻塞性病变,其中胆脂瘤及内陷袋46耳,肉芽肿42耳。经上鼓室外侧壁进路,在颞线下自后上嵴至颧弓后根磨开骨壁,保留菲薄的外耳道后上骨壁和完好天盖,于后拱柱开放面神经隐窝,清除病变组织,修复或重建听骨链,疏通中、上鼓室气流通道,保留鼓窦乳突,完成改良完壁式鼓室成形术。结果术后鼓膜和外耳道完整。局限性上鼓室胆脂瘤及内陷袋患者平均语頻听力较术前提高15-25d BHL;慢性中耳炎上鼓室肉芽患者平均语频听力较术前提高15-30d BHL。随访5.0年未见胆脂瘤复发。结论改良完壁式鼓室成形术,进路便捷,再通气道,疗效满意。

Objective To investigate the efficacy of modified intact canal wall tympanoplasty in treating localized at-tic lesions. Methods Data from 75 patients （88 ears） who underwent surgery for localized attic lesions were retrospectively reviewed. Among all the 88 ears, lesions included localized attic cholesteatoma and retraction pocket （n=46）, chronic otitis media with epitympanic granulation （n=35）, and adhesive otitis media （n=7）. The operation was performed under the tempo-ral line, with bone tissue removed between the suprameatal spine and the dorsal root of zygomatic arch and the tegmen and a meager intact posterior canal wall retained. Next, the attic and posterior tympanum were opened, and the lesion exposed and managed. Ossiculoplasty was performed if the ossicular chain was destroyed. Results Compared with before surgery, hear-ing improved by about 15-25 dB in patients with localized attic cholesteatoma or （and） retraction pocket, by about 15-30 dB in patients with epitympanic granulation and by about 15-20 dB in patients with adhesive otitis media. There was no recur-rent cholesteatoma and the external auditory canal wall and tympanic membrane integrity remained during the 5 years of fol-low-up. Conclusion The goal of modified intact canal wall tympanoplasty in this situation is preservation of normal struc-tures and restoration of ventilation to the attic space while eliminating lesions. Clinical effects of this modified technique are satisfactory.