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目的观察慢性化脓性中耳炎术中采用自体组织充填乳突腔、耳甲腔成形术、WullsteinⅢ鼓室成形术的手术疗效。方法对45例慢性化脓性中耳炎(胆脂瘤型31例,骨疡型14例)患者采用耳后切口,完成开放式乳突根治术后,乳突腔采用自体组织充填、Wullstein鼓室成形术、耳甲腔成形术。结果术后半年平均听力提高15dB(10~22dB),骨气导差缩缩小16dB(8~20.5dB)。全部随访2~5年,平均3.8年,耳内镜检查术腔上皮化好,无痂皮堆积,27例鼓膜正常,5例有裂隙样穿孔,延迟愈合,9例鼓膜内陷,全都干耳,干耳率91.1%(41/45)。4例术后间隙流脓,再次完成同样手术后随访半年未再复发,这4例中3例胆脂瘤复发,复发率6.7%(3/45);41例干耳时间6~9周,平均6.8周。结论慢性化脓性中耳炎(胆脂瘤型与骨疡型)采用开放式乳突根治术,术后乳突腔用自体组织充填、鼓室成形术,同时行耳甲腔成形术,能有效清除病灶,干耳率高,干耳时间短;术后听力提高,术腔上皮化好,疗效满意。
Objective To observe the surgical treatment of chronic suppurative otitis media with autologous tissue filling mastoid cavity, concha aurotomy and Wullstein Ⅲ tympanoplasty. Methods 45 cases of chronic otitis media with cholesteatoma (31 cases of cholesteatoma and 14 cases of bone ulcer) were treated with auricular incision. After radical mastoidectomy, the mastoid cavity was filled with autologous tissue, Wullstein tympanoplasty, Iro-cavitoplasty. Results Six months after operation, the average hearing intensity increased by 15dB (10 ~ 22dB) and the difference of bone conduction was 16dB (8 ~ 20.5dB). All cases were followed up for 2 to 5 years, with an average of 3.8 years. Ear endoscopy showed good epithelialization of the luminal cavity with no accumulation of scabs. Normal tympanic membrane was observed in 27 cases, fissure-like perforation in 5 cases, delayed healing, and erection in 9 cases. , Dry ear rate was 91.1% (41/45). 4 cases of postoperative effusion pus, again completed the same operation after six months of follow-up no recurrence, of which 4 cases of cholesteatoma recurrence, the recurrence rate was 6.7% (3/45); 41 cases of dry ear time 6 to 9 weeks, Average 6.8 weeks. Conclusion Chronic suppurative otitis media (cholesteatoma type and type of bone ulcer) with open mastoidectomy, postoperative mastoid cavity with autologous tissue filling, tympanoplasty, while the line of cavitary cavity angioplasty, which can effectively remove the lesion, Dry ear rate is high, dry ear time is short; improve the postoperative hearing, epithelialization of the cavity is good, the curative effect is satisfactory.