论文部分内容阅读
目的:观察鼓室硬化手术采用综合技术的疗效。方法:回顾性分析151例(167耳)鼓室硬化(不含单纯鼓膜钙化)患者的临床资料。167耳均清除病灶并按需采用综合技术:①探孔开放上鼓室、乳突腔等;②自体骨片盾板修复,或碎骨填塞乳突腔;③听骨处理分为保持听骨链完整和听骨链重建;④可吸收膜片(透明质酸或聚二氧杂环乙酮)防再粘连;⑤鼓索神经弹压听骨;⑥铒-YAG激光或小凿清除面神经管骨质增生。术后1个月内测听力,出院3个月后复查1次,以后6个月~1年随访1次,以最后1次为随访结果(取0.5、1.0、2.0 kHz HL语频均数)。结果:167耳术前、术后气骨导差(ABG)分别为(39.74±12.54)dB和(20.68±11.80)dB,P<0.01。成功71耳(42.5%),有效48耳(28.7%),总有效率为71.3%(119耳)。167耳随访3~60个月,平均(11.01±10.24)个月,随访的ABG为(20.67±13.52)dB,与术前比较,P<0.01;与术后比较,P>0.05。随访12个月以上者96耳,ABG为(21.94±11.16)dB,与167耳随访结果比较,P>0.05。结论:应用综合技术能促进术后听力改善,并维持远期疗效。三骨全固定仍是治疗难点,对镫骨切除术应慎重对待。
Objective: To observe the curative effect of tympanosclerosis using comprehensive technique. Methods: The clinical data of 151 patients (167 ears) with tympanosclerosis (excluding simple tympanic calcification) were retrospectively analyzed. 167 ears were cleared of lesions and the need to adopt a comprehensive technology: ① open the upper drum on the tympanic cavity, mastoid cavity, etc .; ② repair of bone fragments shield, or bone crush mastoid; ③ ossification of the bones into the ossicular chain Complete and ossicular chain reconstruction; ④ absorbable membrane (hyaluronic acid or polydioxanone) anti-adhesion; ⑤ otorrhaphy nerve bulging bone ⑥ erbium-YAG laser or small chisel clear the surface of the neural tube Hyperplasia. Audiometry within 1 month after surgery, 1 review after 3 months of discharge, 6 months to 1 year follow-up and 1 last follow-up result (take 0.5,1.0,2.0 kHz HL language mean) . Results: The preoperative and postoperative APG values were (39.74 ± 12.54) dB and (20.68 ± 11.80) dB, respectively, P <0.01. Successful ears (42.5%), effective 48 ears (28.7%), the total effective rate was 71.3% (119 ears). 167 ears were followed up for 3 to 60 months with an average of (11.01 ± 10.24) months. The follow-up ABG was (20.67 ± 13.52) dB, P <0.01 compared with that before operation, P> 0.05. After a follow-up of 12 months, 96 ears had ABG of (21.94 ± 11.16) dB, which was significantly higher than that of 167 ears (P> 0.05). Conclusion: The application of integrated technology can promote postoperative hearing improvement and maintain long-term efficacy. Three full fixation is still difficult to treat, the stapes resection should be treated with caution.