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目的:研究慢性中耳炎行鼓室成形术的患者高位颈静脉球(HJB)的发生率及HJB裸露并发术中破裂出血的处理。方法:对2005年1月~2006年8月287例慢性中耳炎行鼓室成形术的患者进行回顾性研究,结合高分辨率CT(HRCT)所见及术中处理加以分析。结果:287例慢性中耳炎患者中,HRCT检查发现HJB65例,左侧14例,右侧31例,双侧20例。术中发现颈静脉球顶部骨壁缺损5例,其中1例发生颈静脉球出血,占0.35%(1/287)。以胶原蛋白海绵片封闭静脉裂口,再以合适大小颞肌肌瓣填压后出血控制效果好。发生颈静脉球出血者经止血后,顺利完成了清除病灶、听骨链重建等全部手术步骤。结论:鼓室成形术术前需注意颈静脉球情况,手术中遇到HJB,尤其在颈静脉球与下鼓室间骨壁缺损时易发生颈静脉破裂出血时,颞肌肌瓣及胶原蛋白海绵片是较好的止血材料,同时短暂控制性低血压及术中冷静、及时、恰当的处理也是减少出血、保证安全的重要措施,并可继续完成既定手术。
Objective: To study the incidence of high jugular bulb (HJB) in patients with chronic otitis media undergoing tympanoplasty and the treatment of ruptured hemorrhage in patients with HJB complicated with open surgery. Methods: A retrospective study was performed on 287 patients with tyto otitis media undergoing tympanoplasty between January 2005 and August 2006, and analyzed by high resolution CT (HRCT) and intraoperative management. Results: Of the 287 patients with chronic otitis media, HJB was detected in 65 cases by HRCT, 14 on the left, 31 on the right, and 20 on both sides. Intraoperative findings of 5 cases of the top of the jugular bulb wall defects, including 1 case of jugular bulb bleeding, accounting for 0.35% (1/287). Collagen sponge sheet closed venous rips, and then the appropriate size of the temporalis muscle flap post-pressure bleeding control effect. Occur in jugular vein hemorrhage after hemostasis, the successful completion of the removal of lesions, reconstruction of ossicular chain and all other surgical procedures. Conclusions: The tympanoplasty needs to pay attention to the situation of jugular bulb before surgery, and HJB is encountered in the operation. Especially when jugular bulb rupture occurs easily in the jugular bulb and inferior tympanic cavity, the temporal muscle flap and collagen sponge piece Is a better hemostatic material, while transient hypotensive control and intraoperative calm, timely and appropriate treatment is also an important measure to reduce bleeding, ensure safety and continue to complete the scheduled operation.