耳内切口耳内镜联合显微镜中耳手术

Combined Endoaural Incision,Endoscopy and Microscopy approach in Middle Ear Surgery

目的探讨耳内切口耳内镜联合显微镜中耳手术,治疗慢性中耳炎及中耳胆脂瘤的手术分组方式、手术特点及治疗效果。方法189例(195耳)慢性中耳炎及中耳胆脂瘤,根据颞骨CT检查所见分3组进行耳内切口耳内镜联合显微镜中耳手术,1组:上鼓室开放术;2组:上鼓室-鼓窦开放术;3组:上鼓室-鼓窦-乳突开放术。于术中对各组中耳病变情况、胆脂瘤侵犯范围、手术实际开放范围进行观察记录,与术前手术分组结果进行对比。并观察患耳听力恢复情况、复发情况及干耳情况。结果术前手术分组与术中所见的总符合率95.9%(187/195)。患耳术后反应较轻、恢复快,术后随访半年至1年,无胆脂瘤复发及继发鼓膜穿孔、流脓。161耳进行了听力重建,术后听力改善有效率97.06%(156/161)。结论耳内切口耳内镜联合显微镜中耳手术,分组方法简单、可靠,尽可能的减少了中耳手术磨骨量,又能有效地清理中耳病变、提高听力,使中耳手术更趋个体化、精准化、微创化。

Objective To report indications,surgical techniques and therapeutic outcomes of combined endoaural incision,endoscopic and microscopic approach in middle ear surgery for chronic otitis media and middle ear cholesteatoma.Methods Based on temporal bone CT evaluation,189 cases(195 ears)of chronic otitis media and middle ear cholesteatoma received epitympanotomy(group A),epitympanotomy-atticotomy(group B)or epitympanotomy-atticotomymastoidectomy(group C)via a combined endoaural incision,endoscopic and microscopic approach.Intraoperative findings,including middle ear lesion cholesteatoma invasion and the actual extent of bone removal,were recorded,as well as postoperative hearing,lesion recurrence and rate of dry ear.Results The rate of consistent pre-and intraoperative findings was 95.9%(187/195).Postoperative reaction was mild and recovery rapid,with no recurrence of cholesteatoma nor secondary tympanic perforation or otorrhea during the 6 months to 1 year followed up.Hearing reconstruction was performed in 161 ears,resulting in a rate of hearing improvement of 97.06%(156/161).Conclusion CT scan based surgical method selection is simple and reliable,which can help reduce unnecessary bone removal while allowing effective eradication of middle ear lesions and hearing reconstruction in an individualized,precise and minimally invasive manner.