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
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
目的介绍完壁式乳突切开鼓室成形术治疗活动期慢性化脓性中耳炎的临床效果。方法回顾分析我院采用完壁式乳突切开鼓室成形术治疗的57例(耳)活动期慢性化脓性中耳炎的临床资料。结果48耳术后鼓膜一期愈合,5耳移植筋膜边缘残留裂隙,2-3周...目的介绍完壁式乳突切开鼓室成形术治疗活动期慢性化脓性中耳炎的临床效果。方法回顾分析我院采用完壁式乳突切开鼓室成形术治疗的57例(耳)活动期慢性化脓性中耳炎的临床资料。结果48耳术后鼓膜一期愈合,5耳移植筋膜边缘残留裂隙,2-3周后延期愈合,4耳术后感染鼓膜穿孔未愈合;随访10个月至34个月,无复发病例,57耳的0.5、1.0、2.0、4.0k Hz气导听阈平均值由术前的49.7±9.4d BHL恢复到30.3±8.0 d BHL,气骨导差平均缩小15 d BHL,其中48耳听力有改善。结论采用完壁式乳突切开鼓室成形术治疗活动期慢性化脓性中耳炎,亦可有效清除中耳乳突病灶,重建中耳传导结构,且能保留耳部正常形态,提升患者听力及生活质量。展开更多
目的探讨局限于上鼓室区病变的慢性化脓性中耳炎、中耳胆脂瘤行上鼓室径路保留乳突的改良完壁式鼓室成形术的长期临床疗效。方法诊断慢性化脓性中耳炎、中耳胆脂瘤47例(47耳)患者,结合患者专科检查,依据手术方式不同分A、B两组,A组行上...目的探讨局限于上鼓室区病变的慢性化脓性中耳炎、中耳胆脂瘤行上鼓室径路保留乳突的改良完壁式鼓室成形术的长期临床疗效。方法诊断慢性化脓性中耳炎、中耳胆脂瘤47例(47耳)患者,结合患者专科检查,依据手术方式不同分A、B两组,A组行上鼓室径路保留乳突的改良完壁式鼓室成形术,B组行完壁式乳突切开+鼓室成形术。术后随访5~7年。每种手术方式的患者分别进行术前、术后气导(AC)和术前、术后骨导(BC)的比较以及术前、术后气骨导差(ABG)的比较。对比分析两种手术方式气导改善值及气骨导差缩小值。结合听力改善程度、成功率、复发率、干耳时间,分析并探讨上鼓室径路保留乳突的改良完壁式鼓室成形术在中耳炎性疾病中的临床疗效。结果上鼓室径路保留乳突的改良完壁式鼓室成形术和完壁式乳突切开+鼓室成形术术后听阈改善差别有统计学意义。上鼓室径路保留乳突的改良完壁式鼓室成形术术后气导阈值改善≥30 dB5例(16.7%),20~30 dB11例(36.7%),10~19 dB10例(33.3%),<10 dB 4例(13.3%),术后ABG小于20 dB 28例(93.3%)。两组术后均未见鼓膜穿孔及内陷,未见复发,上鼓室径路保留乳突的改良完壁式鼓室成形术术后干耳时间2~4周,完壁式乳突切开+鼓室成形术术后干耳时间4~7周,上鼓室径路保留乳突的改良完壁式鼓室成形术术后干耳时间更短。结论上鼓室径路保留乳突的改良完壁式鼓室成形术治疗局限于上鼓室区病变的慢性化脓性中耳炎、中耳胆脂瘤疗效满意。展开更多
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。
文摘目的介绍完壁式乳突切开鼓室成形术治疗活动期慢性化脓性中耳炎的临床效果。方法回顾分析我院采用完壁式乳突切开鼓室成形术治疗的57例(耳)活动期慢性化脓性中耳炎的临床资料。结果48耳术后鼓膜一期愈合,5耳移植筋膜边缘残留裂隙,2-3周后延期愈合,4耳术后感染鼓膜穿孔未愈合;随访10个月至34个月,无复发病例,57耳的0.5、1.0、2.0、4.0k Hz气导听阈平均值由术前的49.7±9.4d BHL恢复到30.3±8.0 d BHL,气骨导差平均缩小15 d BHL,其中48耳听力有改善。结论采用完壁式乳突切开鼓室成形术治疗活动期慢性化脓性中耳炎,亦可有效清除中耳乳突病灶,重建中耳传导结构,且能保留耳部正常形态,提升患者听力及生活质量。
文摘目的探讨局限于上鼓室区病变的慢性化脓性中耳炎、中耳胆脂瘤行上鼓室径路保留乳突的改良完壁式鼓室成形术的长期临床疗效。方法诊断慢性化脓性中耳炎、中耳胆脂瘤47例(47耳)患者,结合患者专科检查,依据手术方式不同分A、B两组,A组行上鼓室径路保留乳突的改良完壁式鼓室成形术,B组行完壁式乳突切开+鼓室成形术。术后随访5~7年。每种手术方式的患者分别进行术前、术后气导(AC)和术前、术后骨导(BC)的比较以及术前、术后气骨导差(ABG)的比较。对比分析两种手术方式气导改善值及气骨导差缩小值。结合听力改善程度、成功率、复发率、干耳时间,分析并探讨上鼓室径路保留乳突的改良完壁式鼓室成形术在中耳炎性疾病中的临床疗效。结果上鼓室径路保留乳突的改良完壁式鼓室成形术和完壁式乳突切开+鼓室成形术术后听阈改善差别有统计学意义。上鼓室径路保留乳突的改良完壁式鼓室成形术术后气导阈值改善≥30 dB5例(16.7%),20~30 dB11例(36.7%),10~19 dB10例(33.3%),<10 dB 4例(13.3%),术后ABG小于20 dB 28例(93.3%)。两组术后均未见鼓膜穿孔及内陷,未见复发,上鼓室径路保留乳突的改良完壁式鼓室成形术术后干耳时间2~4周,完壁式乳突切开+鼓室成形术术后干耳时间4~7周,上鼓室径路保留乳突的改良完壁式鼓室成形术术后干耳时间更短。结论上鼓室径路保留乳突的改良完壁式鼓室成形术治疗局限于上鼓室区病变的慢性化脓性中耳炎、中耳胆脂瘤疗效满意。
