本文選題：慢性化膿性中耳炎　切入點(diǎn)：骨瘍型　出處：《浙江大學(xué)》2011年碩士論文

【摘要】：目的探討慢性化膿性中耳炎的手術(shù)策略及術(shù)式選擇,比較不同術(shù)式的臨床特點(diǎn)。 方法本文回顧性分析了本院耳鼻咽喉科2007年——2010年6月收治的248例慢性化膿性中耳炎病例(包括骨瘍型及膽脂瘤型)中73例(73耳)至少隨訪6個月的經(jīng)一期乳突鼓室成形術(shù)治療的病例,比較切除外耳道后壁的乳突鼓室成形術(shù)(canal wall down:CWD)與保留外耳道后壁的乳突鼓室成形術(shù)(canal wall up:CWU)兩種常用術(shù)式的臨床特點(diǎn)。 結(jié)果對各組病變侵犯的范圍、手術(shù)數(shù)量、干耳時間、語言頻率氣導(dǎo)聽閾與氣骨導(dǎo)差縮小程度及慢性化膿性中耳(膽脂瘤型)的復(fù)發(fā)率進(jìn)行比較：CWD組病變侵犯范圍明顯要廣于CWU組,CWD組病變主要集中在乳突、鼓竇、上鼓室及后鼓室,而CWU組主要局限在乳突、鼓竇及上鼓室；CWD及CWU手術(shù)量逐漸增多,但CWU增多更加明顯；CWU組干耳時間(6.2±2.4周)明顯短于CWD組(9.2±3.0周)(F=20.57,P0.01)；CWU組語頻區(qū)聽力提高幅度及氣骨導(dǎo)差縮小程度明顯優(yōu)于CWD組(F=6.32,P0.05；F=8.63,P0.01)；CWD組膽脂瘤型復(fù)發(fā)率為12.5%,而CWU組為16.7%,兩者無統(tǒng)計學(xué)差異(X2=0.162,P0.05)。 結(jié)論盡管目前慢性化膿性中耳炎的手術(shù)治療仍以安全性為根本,但是隨著耳科器械的進(jìn)步及術(shù)者水平的提高,最大限度地保留或恢復(fù)聽力功能也已經(jīng)成為本病外科治療的重要目標(biāo)之一,故一味的進(jìn)行開放式手術(shù)是不可取的,現(xiàn)推薦手術(shù)應(yīng)以鼓竇—上鼓室探查結(jié)合CWU開始,根據(jù)術(shù)中所見決定乳突開放范圍。
[Abstract]:Objective to explore the surgical strategy and choice of operation for chronic suppurative otitis media and to compare the clinical characteristics of different surgical methods. Methods A total of 248 cases of chronic suppurative otitis media (including bone type and cholesteatoma type) in our department of otolaryngology from 2007 to June 2010 were retrospectively analyzed. Tympanoplasty, To compare the clinical characteristics of mastoid tympanoplasty with resection of posterior wall of external auditory meatus and mastoid tympanoplasty with reserved posterior wall of external auditory meatus and mastoid tympanoplasty with preservation of posterior wall of external auditory meatus. Results the extent of lesion invasion, the number of operations, the dry ear time, A comparison was made between the speech frequency hearing threshold, the degree of narrowing of the air-bone conduction difference and the recurrence rate of chronic suppurative middle ear (cholesteatoma type). The extent of lesion invasion in the CWU group was significantly wider than that in the CWU group. The lesions were mainly concentrated in the mastoid process, tympanic sinus, superior tympanic chamber and posterior tympanic chamber. In CWU group, CWD and CWU were mainly localized in mastoid process, tympanic sinus and superior tympanic chamber. But the dry ear time of CWU group was significantly shorter than that of CWD group (9.2 鹵3.0 weeks). The hearing improvement and the reduction of air-bone conductance difference were significantly better in CWU group than that in CWD group. The recurrence rate of cholesteatoma was 12.5in CWU group, and 16.7in CWU group. There was no significant difference between the two groups. Conclusion although the surgical treatment of chronic suppurative otitis media is still based on safety at present, with the progress of ear instruments and the improvement of the operative level, Preserving or restoring hearing function to the maximum extent has also become one of the important targets of surgical treatment of this disease, so it is not advisable to blindly carry out open operation. It is recommended that the operation should begin with the combination of tympanic sinus-subotympanic exploration and CWU. The open range of mastoid process was determined according to the intraoperative findings.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R764

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本文編號：1681626