Objective To investigate the advantages of canal wall reconstruction(CWR) mastoidectomy, a single-stage technique for cholesteatoma removal and posterior external canal wall reconstruction, over the open and closed pr...Objective To investigate the advantages of canal wall reconstruction(CWR) mastoidectomy, a single-stage technique for cholesteatoma removal and posterior external canal wall reconstruction, over the open and closed procedures in terms of cholesteatoma recurrence. Methods: Between June 2002 and December 2005, 38 patients (40 ears) with cholesteatoma were admited to Sun Yat-Sen Memorial Hospital and received surgical treatments. Of these patients, 25 were male with ages ranging between 11 and 60 years(mean = 31.6 years) and 13 were female with ages ranging between 20 and 65 years (mean = 38.8 years). Canal wall reconstruction(CWR)mastoidectomy was performed in 31 ears and canal wall down(CWD) mastoidectomy in 9 ears. Concha cartilage was used for ear canal wall reconstruction in 22 of the 31 CWR procedures and cortical mastoid bone was used in the remaining 9 cases. Results At 0.5 to 4 years follow up, all but one patients remained free of signs of cholesteatoma recurrence, i.e., no retraction pocket or cholesteatoma matrix. One patient, a smoker, needed revision surgery due to cholesteatoma recurrence 1.5 year after the initial operation. The recurrence rate was therefore 3.2% (1/31). Cholesteatoma recurrence was monitored using postoperative CT scans whenever possible. In the case that needed a revision procedure, a retraction pocket was identified by otoendoscopy in the pars flacida area that eventually evolved into a cholesteatoma. A pocket extending to the epitympanum filled with cholesteatoma matrix was confirmed during the revision operation, A decision to perform a modified mastoidectomy was made as the patient refused to quit smoking. The mean air-bone gap in pure tone threshold was 45 dB before surgery and 25 dB after(p < 0.05). There was no difference between using concha cartilage and cortical mastoid bone for the reconstruction regarding air-bone gap improvement, CT findings and otoendoscopic results. Conclusion CWR mastoidectomy can be used for most patients with acquired middle ear cholesteatoma, including children. The CWR technique provides improved exposure of the middle ear, especially the anterior epitympanum, without creating a mastoid bowl and reduces the incidence of residual and recurrent disease, including cholesteatoma and otorrhea.展开更多
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
文摘Objective To investigate the advantages of canal wall reconstruction(CWR) mastoidectomy, a single-stage technique for cholesteatoma removal and posterior external canal wall reconstruction, over the open and closed procedures in terms of cholesteatoma recurrence. Methods: Between June 2002 and December 2005, 38 patients (40 ears) with cholesteatoma were admited to Sun Yat-Sen Memorial Hospital and received surgical treatments. Of these patients, 25 were male with ages ranging between 11 and 60 years(mean = 31.6 years) and 13 were female with ages ranging between 20 and 65 years (mean = 38.8 years). Canal wall reconstruction(CWR)mastoidectomy was performed in 31 ears and canal wall down(CWD) mastoidectomy in 9 ears. Concha cartilage was used for ear canal wall reconstruction in 22 of the 31 CWR procedures and cortical mastoid bone was used in the remaining 9 cases. Results At 0.5 to 4 years follow up, all but one patients remained free of signs of cholesteatoma recurrence, i.e., no retraction pocket or cholesteatoma matrix. One patient, a smoker, needed revision surgery due to cholesteatoma recurrence 1.5 year after the initial operation. The recurrence rate was therefore 3.2% (1/31). Cholesteatoma recurrence was monitored using postoperative CT scans whenever possible. In the case that needed a revision procedure, a retraction pocket was identified by otoendoscopy in the pars flacida area that eventually evolved into a cholesteatoma. A pocket extending to the epitympanum filled with cholesteatoma matrix was confirmed during the revision operation, A decision to perform a modified mastoidectomy was made as the patient refused to quit smoking. The mean air-bone gap in pure tone threshold was 45 dB before surgery and 25 dB after(p < 0.05). There was no difference between using concha cartilage and cortical mastoid bone for the reconstruction regarding air-bone gap improvement, CT findings and otoendoscopic results. Conclusion CWR mastoidectomy can be used for most patients with acquired middle ear cholesteatoma, including children. The CWR technique provides improved exposure of the middle ear, especially the anterior epitympanum, without creating a mastoid bowl and reduces the incidence of residual and recurrent disease, including cholesteatoma and otorrhea.
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。
