54例分期鼓室成形术的随访分析

A retrospective study of 54 cases with chronic otitis media prepared for staging tympanoplasty

目的:通过对计划行分期鼓室成形术的54例慢性化脓性中耳炎患者的术中情况以及实际完成二期听骨链重建术的19例患者的术后听力疗效进行分析,为慢性化脓性中耳炎分期手术方式的选择提供参考。方法:因慢性化脓性中耳炎拟行分期鼓室成形术的患者54例(54耳),均已完成一期手术,鼓室均植入硅胶片预防粘连。已有19例完成二期听骨链重建术,其中10例植入完全人工听骨TORP,9例植入部分人工听骨PORP。听力水平以500、1 000、2 000和4 000Hz的平均气骨导差(ABG)计算。结果:54例患者中,45例鼓室及咽鼓管口黏膜肿胀,18例鼓室纤维粘连,12例镫骨底板固定或被硬化灶包埋。54例患者一期手术前平均ABG为(38.26±7.88)dB。已完成二期手术的19例患者,一期手术前平均ABG为(39.21±7.05)dB,二期手术前平均ABG为(38.82±11.43)dB,二期手术后为(21.77±11.92)dB。患者二期手术术后听力较一期及二期手术术前听力均有显著性提高(P<0.01)。此外,另3例患者一期手术后半年平均ABG为(10.42±10.63)dB,因听力尚可,故推迟行二期手术。随访至今,54例患者均未出现面瘫、感染等中耳手术并发症。结论:慢性化脓性中耳炎手术中有不适宜一期听骨链重建者可采用分期治疗,以达到较好的听力康复效果、减少并发症的发生。

Objective：To analyze the clinical effect of 54 cases with chronic otitls media prepared for staging tympanoplasty and 19 cases finished staging ossicular reconstruction surgery, evaluate the advantages of different surgery technique. Method：Fifty-four cases with chronic otitis media were planned for staging tympanoptasty sur- gery and had been received the first stage surgery. Silicagel plates were placed in the tympanic cavity in order to prevent adhesions. Among them, 19 cases had received the second stage ossicular reconstruction, including 10 ca- ses with TORPs and 9 cases with PORPs. The average air bone gaps（ABG）were measured at four frequencies： 500, 1 000, 2 000 and 4 000 Hz. Result ： Among the 54 cases, 45 cases had swollen mucosa in the tympanic cavity and eustachian tube, 18 cases had tympanic fibrous adhesions, and 12 cases had fixed or sclerotic stapes. The pre- operative ABG of the 54 cases were（38.26±7.88） dB. As for the 19 cases finished the second stage surgery, their preoperative ABG in the first stage were（39. 21±7. 05） dB, the preoperative ABG in the second stage were （38.82±11.43） dB, and the postoperative ABG after the second stage were（21. 77±11. 92） dB. The hearing function after staging tympanoplasty was significantly improved compared with the preoperative hearing in the first and the second stage operation（P^0.01）. In addition, the second stage surgery of three cases was postponed be- cause of a good postoperative hearing with（10.42-＋-10.63） dB ABG after the first stage surgery. Up to now, none of the 54 cases suffered from facial palsy, infection and other complications after surgery. Conclusion：Staging tym- panoplasty is an important technique to improving hearing and reducing the complications, especially for the cases with chronic otitis media unsuitable for one stage reconstruction of ossicular chain.