【摘要】：目的探討慢性中耳炎手術(shù)中,運用多種技術(shù)清除病灶,重建中耳傳音結(jié)構(gòu),提高聽力,防止復發(fā)。 方法選取2009年1月——2010年6月期間,合肥市第一人民醫(yī)院耳鼻咽喉科收住的慢性中耳炎患者50例(50耳)。所有患者均采用耳內(nèi)Y型切口,使用氣鉆、銑鉆、擺鋸及耳顯微手術(shù)器械等,在清除患者病灶的基礎(chǔ)上,根據(jù)患者病變情況,運用自體外耳道-乳突骨皮質(zhì)重建上鼓室外側(cè)壁,外耳道壁及聽骨鏈,術(shù)中使用鼓索神經(jīng)彈壓技術(shù),固定自體聽骨,使用外耳道-乳突骨膜以夾層法修補鼓膜,術(shù)后定期隨訪,并復查純音聽力測試,采用自身對照的方法,對比術(shù)前術(shù)后氣骨導差之間的差異。 結(jié)果50耳中通過術(shù)前、術(shù)后純音聽力測試檢查聽力級較術(shù)前提高10～30db的患耳有44例,手術(shù)成功率為88%。50耳言語頻段術(shù)前術(shù)后平均氣骨導差為17.67±14.63dBHL,經(jīng)過配對t檢驗,p0.01,具有統(tǒng)計學意義,提示患者術(shù)后聽力明顯改善。在術(shù)后長期隨訪觀察中,有45耳(90%)具有正常的外耳道、含氣的中耳腔、形態(tài)正常的鼓膜。此45耳中,術(shù)后氣骨導差18耳(40%)10dB,22耳(49%)20dB,5耳(11%)20dB,此5耳中3耳聽力曲線較術(shù)前提高10～30dB。 結(jié)論在慢性中耳炎手術(shù)中,通過多種技術(shù)的綜合運用,可以在徹底清除病灶的基礎(chǔ)上,重建聽力結(jié)構(gòu),外耳道壁及上鼓室外側(cè)壁,最大限度地保持中耳正常形態(tài),改善聽力,防止復發(fā)。
[Abstract]:Objective to study the effects of various techniques in the treatment of chronic otitis media, to reconstruct the structure of middle ear sound transmission, to improve hearing and to prevent recurrence of chronic otitis media. Methods from January 2009 to June 2010, 50 patients (50 ears) with chronic otitis media were enrolled in the department of otorhinolaryngology, first people's hospital of Hefei. All patients were treated with Y-shaped incision, air drill, milling drill, swing saw and ear microsurgical instruments, etc. On the basis of removing the lesions of the patients, the lateral wall of the upper tympanic chamber was reconstructed with the autogenous auditory meatus-mastoid cortex according to the pathological changes of the patients. The wall of external auditory meatus and ossicular chain were fixed by the technique of elastic compression of tympanic cord nerve, and the tympanic membrane was repaired by mezzanine technique of external auditory meatus-mastoid periosteum. The patients were followed up regularly after operation, and the pure tone hearing test was reexamined, and the method of self-control was used. The differences of air-bone conduction before and after operation were compared. Results among 50 ears, 44 ears with 10~30db improved by pure tone audiometry before and after operation, and the successful rate of operation was 88%. The mean air-bone conduction difference was 17.67 鹵14.63 dBHLL before and after operation in the speech band of 50 ears, and the difference of air-bone conduction between pre-operation and post-operation was 17.67 鹵14.63 dBHL in 50 ears. After paired t-test, p0.01 had statistical significance, suggesting that the patients' hearing was improved obviously after operation. During the long-term follow-up observation, 45 ears (90%) had normal external auditory meatus, air-bearing middle ear cavity and normal tympanic membrane. Of the 45 ears, 18 ears (40%) had postoperative air-bone conduction difference of 10 dB, 22 ears (49%) 20 dB, 5 ears (11%) 20 dB. Conclusion in the operation of chronic otitis media, the hearing structure, the wall of the external auditory canal and the lateral wall of the upper tympanic chamber can be reconstructed on the basis of the thorough removal of the lesion, and the normal shape of the middle ear can be maintained to the maximum extent, and the hearing can be improved through the comprehensive application of various techniques in the operation of chronic otitis media. Prevent recurrence.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R764

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