CAJ | 학술논문

目的探讨自体软骨和Tos改良联合进路鼓室成形术在中耳手术中的临床应用.方法对23例胆脂瘤型中耳炎用Tos改良的联合进路行鼓室成形术进行治疗,去除的上鼓室外侧壁和后鼓室外侧壁,用耳屏软骨重建,再视镫骨状况,同时用部分听小骨赝复体(PORP)或全听小骨赝复体(TORP)行Ⅲ型听骨链重建.所有病例随访3至5年.结果所有23例患者在术后4至6周获得干耳,鼓膜愈合好,形态正常.软骨重建的上鼓室和后鼓室外侧壁无1例内陷.术后1年纯音听力,言语频率(500、1000、2000、3000、4000Hz)气导较术前提高≥30dB者8例(34.78%),20～29dB者9例(39.13%),10～19dB者4例(17.39%),听力无改善者2例(8.69%).随访3年,听力稳定,5年内无胆脂瘤复发.结论 Tos改良的联合进路鼓室成形术是胆脂瘤型中耳炎手术治疗的好方法,既彻底清除病灶,又保留外耳道后壁完整,术后能获得良好的听力.Tos改良术因去除了上鼓室和后鼓室外侧壁,用软骨重建可有效的防止新生鼓膜的内陷和继发胆脂瘤形成.
목적 탐토자체연골화Tos개량연합진로고실성형술재중이수술중적림상응용.방법 대23례담지류형중이염용Tos개량적연합진로행고실성형술진행치료,거제적상고실외측벽화후고실외측벽,용이병연골중건,재시등골상황,동시용부분은소골안복체(PORP)혹전은소골안복체(TORP)행Ⅲ형은골련중건.소유병례수방3지5년.결과 소유23례환자재술후4지6주획득간이,고막유합호,형태정상.연골중건적상고실화후고실외측벽무1례내함.술후1년순음은력,언어빈솔(500、1000、2000、3000、4000Hz)기도교술전제고≥30dB자8례(34.78%),20～29dB자9례(39.13%),10～19dB자4례(17.39%),은력무개선자2례(8.69%).수방3년,은력은정,5년내무담지류복발.결론 Tos개량적연합진로고실성형술시담지류형중이염수술치료적호방법,기철저청제병조,우보류외이도후벽완정,술후능획득량호적은력.Tos개량술인거제료상고실화후고실외측벽,용연골중건가유효적방지신생고막적내함화계발담지류형성.
Objective To explore the clinical application of autologous cartilage and Tos modified combined approach tympanoplaty in middle ear surgery. Methods Twenty-three patients with chronic otitis media with cholesteatoma received tympanoplasty with Tos modified combined approach. The lateral walls of epitympanum and posterior tympanum were removed and reconstructed with tragal cartilages. Type Ⅲ ossicular reconstruction was performed either with partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP), depending on the stapes situation. All the patients were followed up for 3-5 years. Results Four to six weeks after surgery, all the 23 patients experienced dry ear and wellhealed tympanic membranes with normal appearance. Depression of lateral walls of epitympanum and posterior tympanum after cartilage reconstruction was not seen in any case. One year after surgery, pure tone audiometry one showed that speech frequency (500, 1000, 2000, 3000, 4000 Hz), air conduction hearing threshold increased by at least 30 dB in 8 patients (34.78%), by 20-29 dB in 9 (39.13%), 10-19 dB in 4 (17.39%) and no improvement in 2 (8.69%). According to the first 3 years of follow-up, patients were with stable audition, and no cholesteatoma relapsed during follow-up of 5 years. Conclusions The tympanoplasty with Tos modified combined approach can be a good solution for surgical treatment of chronic otitis media with cholesteatoma since it can not only remove the lesions completely, but also keep the posterior wall of external tympanic meatus intact, with a satisfying postoperative hearing level obtained. The cartilage reconstruction of the lateral walls of epitympanum and posterior tympanum removed during surgery is effective to prevent depression of new tympanic membrane and formation of secondary cholesteatoma.