CAJ | 학술논문

目的探讨完壁式乳突切开联合面隐窝开放在治疗儿童分泌性中耳炎中的临床价值.方法回顾性分析2005年6月至2007年6月中山大学附属第二医院耳鼻咽喉头颈外科收治的17例(19耳)反复发作,行鼓膜置管3次以上无效的儿童分泌性中耳炎患者的临床资料,19耳均接受完壁式乳突切开联合面隐窝开放术治疗,其中7耳术中探杳咽鼓管欠通畅,同期行鼓膜置管术,置管后1～3个月拔管.结果 19耳中耳乳突炎性组织的病理检杳结果显示,9耳为中耳胆固醇肉芽肿,10耳为炎性肉芽.术后19耳均获痊愈,鼓膜形态正常.鼓室压图为A型曲线者16耳,C型曲线者3耳,且负压均在150 mm H2O(1 cm H2O=O.098 kPa)内.术后3个月纯音测听骨气导差均在15 dB以内,随访2～3年无复发.结论儿童分泌性中耳炎如果反复发作,在多次行鼓膜置管无效的情况下,可考虑采用完壁式乳突切开联合面隐窝开放术式彻底清除病灶,从而建立长期有效的咽鼓管、鼓室、鼓窦、乳突的通气引流,该术式有效.
목적 탐토완벽식유돌절개연합면은와개방재치료인동분비성중이염중적림상개치.방법 회고성분석2005년6월지2007년6월중산대학부속제이의원이비인후두경외과수치적17례(19이)반복발작,행고막치관3차이상무효적인동분비성중이염환자적림상자료,19이균접수완벽식유돌절개연합면은와개방술치료,기중7이술중탐묘인고관흠통창,동기행고막치관술,치관후1～3개월발관.결과 19이중이유돌염성조직적병리검묘결과현시,9이위중이담고순육아종,10이위염성육아.술후19이균획전유,고막형태정상.고실압도위A형곡선자16이,C형곡선자3이,차부압균재150 mm H2O(1 cm H2O=O.098 kPa)내.술후3개월순음측은골기도차균재15 dB이내,수방2～3년무복발.결론 인동분비성중이염여과반복발작,재다차행고막치관무효적정황하,가고필채용완벽식유돌절개연합면은와개방술식철저청제병조,종이건립장기유효적인고관、고실、고두、유돌적통기인류,해술식유효.
Objective To investigate the clinical significance of intact canal wall mastoidectomy combined with facial recess opening in the treatment of secretory otitis media of children. Methods The clinical data of 17 children ( 19 ears) with recurrent secretory otitis media yet failed tube insertion more than 3 times, and treated with intact canal wall mastoidectomy combined with facial recess opening, in the Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of SUN Yat-sen University, were reviewed. And because of the eustachian tube dysfunction, 7 ears simultaneously accepted tube insertion, which were removed after 1 to 3 months. Results Pathological examination of the lesions in middle ear and mastoid of the 19 ears, revealed cholesterol granuloma in 9 ears and inflammatory granulation in 10 ears. All 19 ears recovered with normal tympanic membranes. There were 16 ears with type A tympanogram and 3 ears with type C tympanogram ( negative pressure less than 150 mm H2O). The air-bone gaps were less than 15 dB in 3 months after surgery. There was no recurrence in all cases after 2 - 3 years follow-up. Conclusions In case of recurrent otitis media in children, especially when tube insertion is ineffective, intact canal wall mastoidectomy combined with facial recess opening can be adopted to clear the lesions thoroughly, and to establish long-time and effective ventilation of eustachian tube, tympanic cavity,tympanic antrum, and mastoid.