目的评估完壁式乳突切除术(CWUM)联合鼓室成形术治疗慢性化脓性中耳炎(CSOM)的效果。方法 130例CSOM患者按照手术方式不同分为研究组(完壁式乳突切除术+鼓室成形术)与对照组(开放式乳突切除术+鼓室成形术),每组各65例。术后随访24个月,...目的评估完壁式乳突切除术(CWUM)联合鼓室成形术治疗慢性化脓性中耳炎(CSOM)的效果。方法 130例CSOM患者按照手术方式不同分为研究组(完壁式乳突切除术+鼓室成形术)与对照组(开放式乳突切除术+鼓室成形术),每组各65例。术后随访24个月,比较2组患者治疗前后纯音听力、术后主观听力改善、平均干耳时间及并发症情况。结果研究组与对照组术后24个月的纯音听阈阈值分别比术前降低22.59 d B和11.42 d B;组内手术前后及组间术后听力改善比较差异均有统计学意义(P值均<0.05)。研究组术后24个月主观听力改善优于对照组(P<0.05)。研究组与对照组术后干耳所需时间分别为49.16 d和36.95 d,组间差异具有统计学意义(P<0.05)。2组术后并发症发生率比较差异无统计学意义(P>0.05)。结论 CWUM联合鼓室成形术治疗CSOM对于符合适应证的患者,能够完整清除病灶,改善患者听力,疗效确切。手术医师需要根据患者病变情况合理选择CWUM或开放式乳突切除术。展开更多
目的探讨分泌性中耳炎后遗疾病的手术策略及疗效。方法回顾性分析49例(49耳)分泌性中耳炎后遗疾病(病程≥3个月,经鼓膜穿刺、置管或咽鼓管球囊扩张术治疗无效,颞骨CT示中耳乳突继发软组织病变)且行中耳乳突手术患者的临床资料,按颞骨CT...目的探讨分泌性中耳炎后遗疾病的手术策略及疗效。方法回顾性分析49例(49耳)分泌性中耳炎后遗疾病(病程≥3个月,经鼓膜穿刺、置管或咽鼓管球囊扩张术治疗无效,颞骨CT示中耳乳突继发软组织病变)且行中耳乳突手术患者的临床资料,按颞骨CT提示中耳病变范围不同分为两组:(1)上鼓室入路组16耳,病变局限于鼓室、鼓窦,行显微镜下上鼓室切开+鼓室成形术,其中3耳同期行听骨链重建术、9耳行鼓室置管术;(2)乳突入路组33耳,病变侵及乳突,行显微镜下完壁式乳突切开+鼓室成形术,其中7耳同期行听骨链重建术、18耳行鼓室置管术,6耳行咽鼓管球囊扩张术。术后1年复查纯音听阈,比较两组疗效。结果上鼓室入路组5耳为胶冻样粘稠分泌物填塞上鼓室,炎性肉芽7耳,胆固醇肉芽肿3耳,鼓室硬化1耳;乳突入路组炎性肉芽16耳、胆固醇肉芽肿15耳、鼓室硬化2耳;术后1年复查,上鼓室入路组言语频率平均气导阈值从术前39.2±15.1 dB HL恢复到术后28.2±12.1 dB HL(P=0.0303),有效率87.5%(14/16);乳突入路组从术前56.1±22.4 dB HL恢复到术后37.3±15.6 dB HL(P=0.002),有效率84.8%(28/33);两组总有效率85.7%(42/49)。结论对于分泌性中耳炎后遗疾病术前可根据颞骨CT提示中耳病变范围选择不同手术入路;术中切除病变同时应注重鼓室通气系统功能的重建,结合鼓室病变、鼓膜情况及咽鼓管功能选择个体化手术治疗方案,可取得良好效果。展开更多
目的探讨顽固性分泌性中耳炎(otitis media with effusion,OME)及相关后遗症的手术治疗策略及疗效。方法回顾分析复旦大学附属眼耳鼻喉科医院2014年7月-2017年12月期间收治的顽固性OME患者29例(31耳),31耳均接受了完壁式乳突切除,其中1...目的探讨顽固性分泌性中耳炎(otitis media with effusion,OME)及相关后遗症的手术治疗策略及疗效。方法回顾分析复旦大学附属眼耳鼻喉科医院2014年7月-2017年12月期间收治的顽固性OME患者29例(31耳),31耳均接受了完壁式乳突切除,其中15耳同期行鼓膜置管术;6耳应用人工听骨行听骨链重建;5耳对鼓膜进行了修复。结果28耳获痊愈;3耳在术后6-12月时出现复发,改为开放式乳突切除+鼓膜置管术,均治愈。术后(包括再次手术)6个月复查纯音测听,语言频率(0.5-2KHz)气导平均值12-50dB[(33.06±10.82)dB],气骨导差在5-21 dB[(11.00±4.13)dB]之间。鼓室导抗图恢复为A型曲线者29耳,C型曲线2耳,但负压均在150 mm H20(1mm H20=0.0098 kPa)内。术后随访8个月-4年,31耳均无复发。结论经过各种方法治疗无效的慢性OME应考虑到有长期OME导致的不可逆并发症的可能性,积极采取中耳乳突手术治疗。展开更多
目的观察在保持外耳道后壁完整的情况下,上鼓室切开软骨重建技术在中耳炎手术中的应用及疗效。方法对45例(耳)中耳胆脂瘤和13例(耳)活动期中耳炎患者,在保留外耳道后壁乳突切开、上鼓室外侧壁切除或及经砧骨窝向下开放面隐窝,清除听骨链...目的观察在保持外耳道后壁完整的情况下,上鼓室切开软骨重建技术在中耳炎手术中的应用及疗效。方法对45例(耳)中耳胆脂瘤和13例(耳)活动期中耳炎患者,在保留外耳道后壁乳突切开、上鼓室外侧壁切除或及经砧骨窝向下开放面隐窝,清除听骨链区(包括上鼓室、中后鼓室)及鼓窦乳突区病变后,行上鼓室软骨封闭重建术,术后随访12～36个月,观察术后中耳炎胆脂瘤复发、鼓膜形态及听力提高等情况。结果 58例(耳)术后重建的上鼓室外侧壁与保留的外耳道后壁相连接。本组病例中6例术后外耳道后壁肿胀或皮肤缺损,继续换药4～5次后愈合良好; 3例患者出院后仍有少量流脓,鼓膜边缘穿孔,门诊局部给药后延迟愈合; 3例听骨脱出、2例鼓膜再穿孔、2例24个月后原胆脂瘤复发,行开放式手术后治愈。术后6个月复查纯音听力测试,并与术前进行比较,听力均有不同程度提高,0. 5、1、2 kHz气骨导差平均减10 d B,气导听阈平均提高15 d B左右。结论在保持外耳道后壁完整的情况下,上鼓室切开软骨重建技术在中耳炎外科手术中的应用,既能够充分暴露病变,病灶清除彻底,同时又保留了外耳道的形态,可有效防止鼓膜回缩袋的形成,降低了胆脂瘤的复发,又避免了开放式手术所残留的宽大术腔。术后鼓膜形态恢复良好,从而保持或提高了患者的听力。展开更多
In this retrospective study,we evaluated the preoperative and intraoperative findings and functional results of revision surgery after canal wall down mastoidectomy.We reviewed 34 patients(14 men,20 women;age,17–68 y...In this retrospective study,we evaluated the preoperative and intraoperative findings and functional results of revision surgery after canal wall down mastoidectomy.We reviewed 34 patients(14 men,20 women;age,17–68 years)who underwent revision canal wall down mastoidectomy from March 2006 to March 2017 in the Department of Otology of the First Affiliated Hospital,Wenzhou Medical University,China.This study was approved by the Ethics Committee of the First Affiliated Hospital,Wenzhou Medical University,China(approval No.2008-05-02A11)on May 2,2008.The possible reasons for previous surgical failures were confirmed by the operative findings and included a narrow auditory meatus orifice(100%),recurrent or residual cholesteatoma(82%),high facial ridge(94%),residual air cells(47%),and labyrinthine fistula(12%).The mean time until achievement of dry ear after surgery was 5.8±2.4 weeks.After a mean 6-month follow-up,the mean postoperative air–bone gap decreased from 33.8±4.8 to 17.1±5.1dB in 30 patients who underwent mastoidectomy with simultaneous tympanoplasty.However,no significant postoperative hearing change had occurred in the other 4 patients with eustachian tube occlusion.All patients were followed up for>24 months with a disease-free dry ear and stable hearing results.The main reasons for lack of dry ears after mastoidectomy were a narrow auditory meatus orifice,recurrent or residual cholesteatoma,high facial ridge,and residual air cells.Early dry ear and hearing promotion are obtainable in most patients using revision canal wall down mastoidectomy.展开更多
Pediatric cholesteatoma causes extensive destruction within the middle ear and adjacent structures. Despite advancements in surgical techniques, the management of pediatric cholesteatoma remains controversial due to t...Pediatric cholesteatoma causes extensive destruction within the middle ear and adjacent structures. Despite advancements in surgical techniques, the management of pediatric cholesteatoma remains controversial due to the varied presentations and its rapid progression. This study aims to evaluate the presentation of symptoms, otoscopic findings, surgical outcomes, and functional results in a series of pediatric cholesteatoma patients at our institution. A total of 18 patients, aged 5 - 14 years, underwent canal wall down (CWD) or intact canal wall (ICW) surgery based on the extent of disease as assessed intraoperatively. The study focused on the sites involved by cholesteatoma, the surgical challenges encountered, and the techniques employed. Outcomes measured included the incidence of residual and recurrent cholesteatoma, as well as hearing function at follow-up. Our results indicated a 69% improvement in the air-bone gap (ABG) among patients, with residual perforation observed in 4% of cases and no recurrences during the follow-up period. The increased selection of the CWD technique correlated with the extensive nature of the disease presentation. This study underscores the necessity for individualized treatment plans in pediatric cholesteatoma management, considering the aggressive nature of the disease and the need for a balance between eradication and hearing preservation.展开更多
文摘目的评估完壁式乳突切除术(CWUM)联合鼓室成形术治疗慢性化脓性中耳炎(CSOM)的效果。方法 130例CSOM患者按照手术方式不同分为研究组(完壁式乳突切除术+鼓室成形术)与对照组(开放式乳突切除术+鼓室成形术),每组各65例。术后随访24个月,比较2组患者治疗前后纯音听力、术后主观听力改善、平均干耳时间及并发症情况。结果研究组与对照组术后24个月的纯音听阈阈值分别比术前降低22.59 d B和11.42 d B;组内手术前后及组间术后听力改善比较差异均有统计学意义(P值均<0.05)。研究组术后24个月主观听力改善优于对照组(P<0.05)。研究组与对照组术后干耳所需时间分别为49.16 d和36.95 d,组间差异具有统计学意义(P<0.05)。2组术后并发症发生率比较差异无统计学意义(P>0.05)。结论 CWUM联合鼓室成形术治疗CSOM对于符合适应证的患者,能够完整清除病灶,改善患者听力,疗效确切。手术医师需要根据患者病变情况合理选择CWUM或开放式乳突切除术。
文摘目的探讨分泌性中耳炎后遗疾病的手术策略及疗效。方法回顾性分析49例(49耳)分泌性中耳炎后遗疾病(病程≥3个月,经鼓膜穿刺、置管或咽鼓管球囊扩张术治疗无效,颞骨CT示中耳乳突继发软组织病变)且行中耳乳突手术患者的临床资料,按颞骨CT提示中耳病变范围不同分为两组:(1)上鼓室入路组16耳,病变局限于鼓室、鼓窦,行显微镜下上鼓室切开+鼓室成形术,其中3耳同期行听骨链重建术、9耳行鼓室置管术;(2)乳突入路组33耳,病变侵及乳突,行显微镜下完壁式乳突切开+鼓室成形术,其中7耳同期行听骨链重建术、18耳行鼓室置管术,6耳行咽鼓管球囊扩张术。术后1年复查纯音听阈,比较两组疗效。结果上鼓室入路组5耳为胶冻样粘稠分泌物填塞上鼓室,炎性肉芽7耳,胆固醇肉芽肿3耳,鼓室硬化1耳;乳突入路组炎性肉芽16耳、胆固醇肉芽肿15耳、鼓室硬化2耳;术后1年复查,上鼓室入路组言语频率平均气导阈值从术前39.2±15.1 dB HL恢复到术后28.2±12.1 dB HL(P=0.0303),有效率87.5%(14/16);乳突入路组从术前56.1±22.4 dB HL恢复到术后37.3±15.6 dB HL(P=0.002),有效率84.8%(28/33);两组总有效率85.7%(42/49)。结论对于分泌性中耳炎后遗疾病术前可根据颞骨CT提示中耳病变范围选择不同手术入路;术中切除病变同时应注重鼓室通气系统功能的重建,结合鼓室病变、鼓膜情况及咽鼓管功能选择个体化手术治疗方案,可取得良好效果。
文摘目的探讨顽固性分泌性中耳炎(otitis media with effusion,OME)及相关后遗症的手术治疗策略及疗效。方法回顾分析复旦大学附属眼耳鼻喉科医院2014年7月-2017年12月期间收治的顽固性OME患者29例(31耳),31耳均接受了完壁式乳突切除,其中15耳同期行鼓膜置管术;6耳应用人工听骨行听骨链重建;5耳对鼓膜进行了修复。结果28耳获痊愈;3耳在术后6-12月时出现复发,改为开放式乳突切除+鼓膜置管术,均治愈。术后(包括再次手术)6个月复查纯音测听,语言频率(0.5-2KHz)气导平均值12-50dB[(33.06±10.82)dB],气骨导差在5-21 dB[(11.00±4.13)dB]之间。鼓室导抗图恢复为A型曲线者29耳,C型曲线2耳,但负压均在150 mm H20(1mm H20=0.0098 kPa)内。术后随访8个月-4年,31耳均无复发。结论经过各种方法治疗无效的慢性OME应考虑到有长期OME导致的不可逆并发症的可能性,积极采取中耳乳突手术治疗。
文摘目的观察在保持外耳道后壁完整的情况下,上鼓室切开软骨重建技术在中耳炎手术中的应用及疗效。方法对45例(耳)中耳胆脂瘤和13例(耳)活动期中耳炎患者,在保留外耳道后壁乳突切开、上鼓室外侧壁切除或及经砧骨窝向下开放面隐窝,清除听骨链区(包括上鼓室、中后鼓室)及鼓窦乳突区病变后,行上鼓室软骨封闭重建术,术后随访12～36个月,观察术后中耳炎胆脂瘤复发、鼓膜形态及听力提高等情况。结果 58例(耳)术后重建的上鼓室外侧壁与保留的外耳道后壁相连接。本组病例中6例术后外耳道后壁肿胀或皮肤缺损,继续换药4～5次后愈合良好; 3例患者出院后仍有少量流脓,鼓膜边缘穿孔,门诊局部给药后延迟愈合; 3例听骨脱出、2例鼓膜再穿孔、2例24个月后原胆脂瘤复发,行开放式手术后治愈。术后6个月复查纯音听力测试,并与术前进行比较,听力均有不同程度提高,0. 5、1、2 kHz气骨导差平均减10 d B,气导听阈平均提高15 d B左右。结论在保持外耳道后壁完整的情况下,上鼓室切开软骨重建技术在中耳炎外科手术中的应用,既能够充分暴露病变,病灶清除彻底,同时又保留了外耳道的形态,可有效防止鼓膜回缩袋的形成,降低了胆脂瘤的复发,又避免了开放式手术所残留的宽大术腔。术后鼓膜形态恢复良好,从而保持或提高了患者的听力。
文摘目的:比较完壁式(canal wall up,CWU)与开放式(canal wall down,CWD)乳突根治鼓室成形术治疗慢性化脓性中耳炎与中耳胆脂瘤的疗效。方法:通过计算机检索中国知网期刊数据库(CNKI)、万方数据库、维普数据库(VIP)、PubMed、Cochrane Library、Web of Science及Elsevier Clinicalkey数据库从2000年1月至2019年12月的文献,纳入比较CWU与CWD乳突根治鼓室成形术治疗慢性化脓性中耳炎与中耳胆脂瘤疗效的随机对照研究与病例对照研究。采用RevMan5.3软件包对纳入文献进行Meta分析,分析两种术式的术后气导听阈(pure tone average,PTA)、术后气骨导差气骨导差(air bone gap,ABG)、并发症、干耳时间与复发率。结果:共9篇符合纳入标准的文献,其中5篇为随机对照研究,4篇为病例对照研究。总患病耳数为778耳,348耳行CWU乳突根治鼓室成形术,430耳行CWD乳突根治鼓室成形术。两种手术方式的平均PTA差异有统计学意义(MD=−6.99,95%CI:−12.40~−1.58,P=0.01),CWU较CWD好;两种手术方式的术后ABG差异无统计学意义(MD=−2.88,95%CI:−7.11~1.35,P=0.18);CWU及CWD的复发率分别为20.6%(20/97)和4%(4/98),差异具有统计学意义(OR=5.42,95%CI:1.92~15.31,P=0.001);与CWD相比,CWU手术并发症少(OR=0.37,95%CI:0.14~0.96,P=0.04),干耳时间短(MD=–15.19,95%CI:–19.12~–11.27,P<0.001),差异具有统计学意义。结论:CWU乳突根治鼓室成形术干耳时间短,手术并发症少,但具有较高的复发率;与开放术式相比,CWU提高患者术后听力的效果并不显著。手术方案需结合患者的病变性质、病变程度、术前听力状况、随访条件及医师的技术能力等方面来制定。
基金supported by Zhejiang Provincial Natural Science Foundation of China,No.LY19H130003(to YH),LY19H130004(to HL)Wenzhou Basic Scientific Research Project of China,No.Y20180091(to YH).
文摘In this retrospective study,we evaluated the preoperative and intraoperative findings and functional results of revision surgery after canal wall down mastoidectomy.We reviewed 34 patients(14 men,20 women;age,17–68 years)who underwent revision canal wall down mastoidectomy from March 2006 to March 2017 in the Department of Otology of the First Affiliated Hospital,Wenzhou Medical University,China.This study was approved by the Ethics Committee of the First Affiliated Hospital,Wenzhou Medical University,China(approval No.2008-05-02A11)on May 2,2008.The possible reasons for previous surgical failures were confirmed by the operative findings and included a narrow auditory meatus orifice(100%),recurrent or residual cholesteatoma(82%),high facial ridge(94%),residual air cells(47%),and labyrinthine fistula(12%).The mean time until achievement of dry ear after surgery was 5.8±2.4 weeks.After a mean 6-month follow-up,the mean postoperative air–bone gap decreased from 33.8±4.8 to 17.1±5.1dB in 30 patients who underwent mastoidectomy with simultaneous tympanoplasty.However,no significant postoperative hearing change had occurred in the other 4 patients with eustachian tube occlusion.All patients were followed up for>24 months with a disease-free dry ear and stable hearing results.The main reasons for lack of dry ears after mastoidectomy were a narrow auditory meatus orifice,recurrent or residual cholesteatoma,high facial ridge,and residual air cells.Early dry ear and hearing promotion are obtainable in most patients using revision canal wall down mastoidectomy.
文摘Pediatric cholesteatoma causes extensive destruction within the middle ear and adjacent structures. Despite advancements in surgical techniques, the management of pediatric cholesteatoma remains controversial due to the varied presentations and its rapid progression. This study aims to evaluate the presentation of symptoms, otoscopic findings, surgical outcomes, and functional results in a series of pediatric cholesteatoma patients at our institution. A total of 18 patients, aged 5 - 14 years, underwent canal wall down (CWD) or intact canal wall (ICW) surgery based on the extent of disease as assessed intraoperatively. The study focused on the sites involved by cholesteatoma, the surgical challenges encountered, and the techniques employed. Outcomes measured included the incidence of residual and recurrent cholesteatoma, as well as hearing function at follow-up. Our results indicated a 69% improvement in the air-bone gap (ABG) among patients, with residual perforation observed in 4% of cases and no recurrences during the follow-up period. The increased selection of the CWD technique correlated with the extensive nature of the disease presentation. This study underscores the necessity for individualized treatment plans in pediatric cholesteatoma management, considering the aggressive nature of the disease and the need for a balance between eradication and hearing preservation.
