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目的探讨儿童慢性化脓性中耳炎(CSOM)的病变特点及手术方式的选择。方法在行手术治疗的儿童CSOM患者82例中,2例双耳病变者先行1耳手术,手术方式选择乳突根治术60例、改良乳突根治术20例、鼓室成形术2例。从术前并发症、病变范围、听骨破坏情况以及术后并发症等方面探讨其临床特征。结果82例手术中胆脂瘤型56例(68.2%),慢性化脓性中耳炎伴肉芽26例(31.7%),病变范围广泛,多累及外耳道鼓室、鼓窦、鼓窦入口,而听小骨破坏程度最重。术后随访0.5~2年,并发症出现有外耳道口狭窄8例,术腔增生挛缩8例;胆脂瘤复发1例,因术前病变严重术后面瘫未恢复1例。结论儿童CSOM其术前并发症中以颅外并发症多见,年龄越小病变程度越重,对其手术彻底清除病灶应放在首位,根据病变的情况选择不同的手术方式和主动定期随访可以有效降低术后复发率,经典的乳突根治术对儿童不宜采用。
Objective To investigate the pathological features and surgical methods of children with chronic suppurative otitis media (CSOM). Methods Among the 82 CSOM patients undergoing surgical treatment, 2 cases of bilateral ear lesion were treated with 1 ear operation. Sixty cases of radical mastoidectomy, 20 cases of radical mastoidectomy and two cases of tympanoplasty were selected. From the preoperative complications, the scope of the disease, the destruction of the ossicles and postoperative complications and other aspects of its clinical features. Results There were 56 cholesteatoma cases (68.2%) in 82 cases and 26 (31.7%) cases of chronic suppurative otitis media with granuloma. The lesions ranged widely, involving the tympanic cavity of the external auditory canal, The heaviest. The patients were followed up for 0.5 to 2 years. There were 8 cases of external auditory canal stenosis and 8 cases of intraoperative systolic and contractile contracture in 8 cases. The recurrence of cholesteatoma was found in 1 case. There was no recurred facial paralysis in 1 case. Conclusion CSOM in children with preoperative complications more common extracranial complications, the younger the more severe lesions, the complete removal of the lesion should be placed in the first place, according to the lesion to choose a different surgical approach and take the initiative to follow up regularly Effectively reduce the recurrence rate, the classic mastodesis should not be used in children.