CAJ | 학술논문

目的探讨慢性化脓性中耳炎鼓室成形术的可行性和疗效.方法对33例单侧慢性化脓性中耳炎患者在恢复咽鼓管功能、清除病变的同时行鼓室成形术,随访观察近期及远期疗效.结果 33例患者中,3例术腔填塞时有耳鸣,取出填塞物后即恢复正常.术后2周去除外耳道填塞物后,27例移植片色泽正常,生长好,4例血液供应稍差,2例移植片下缘有裂隙,经对症处理后,移植物全部存活.随访至术后1年,鼓膜生长良好28例,占85%;2例半年后再发生鼓膜穿孔,但鼓室内干燥;1例移植的鼓膜穿孔后再流脓;1例移植物内陷,经咽鼓管吹张后好转;1例鼓膜内陷较明显,听力无改善.术后1年纯音测听语频区气骨导差较术前平均缩小10 dB者9例,占27%;缩小15～20 dB者14例,占42%;缩小25～30 dB者6例,占18%;无变化4例,占12%.结论慢性化脓性中耳炎可行鼓室成形术.彻底清除病变,恢复中耳通气功能,加强抗感染,正确放置移植物并防止其感染;避免不愈合及胆脂瘤形成,是手术成功的关键.
목적 탐토만성화농성중이염고실성형술적가행성화료효.방법 대33례단측만성화농성중이염환자재회복인고관공능、청제병변적동시행고실성형술,수방관찰근기급원기료효.결과 33례환자중,3례술강전새시유이명,취출전새물후즉회복정상.술후2주거제외이도전새물후,27례이식편색택정상,생장호,4례혈액공응초차,2례이식편하연유렬극,경대증처리후,이식물전부존활.수방지술후1년,고막생장량호28례,점85%;2례반년후재발생고막천공,단고실내간조;1례이식적고막천공후재류농;1례이식물내함,경인고관취장후호전;1례고막내함교명현,은력무개선.술후1년순음측은어빈구기골도차교술전평균축소10 dB자9례,점27%;축소15～20 dB자14례,점42%;축소25～30 dB자6례,점18%;무변화4례,점12%.결론 만성화농성중이염가행고실성형술.철저청제병변,회복중이통기공능,가강항감염,정학방치이식물병방지기감염;피면불유합급담지류형성,시수술성공적관건.
Objective To discuss the feasibility and curative effect of tympanoplasty for chronic suppurative otitis media. Methods Thirty-three cases of chronic suppurative otitis media in the period of infection had infected tissue removed and the Eustachian tube restored during tympanoplasty. The short-and long-term curative effects were observed by follow-up visit. Results Among the 33 cases, 3 cases are found tinnitus during tamponading the cavity during operation and normal state resumeed after the tampons were taken out. 2 weeks after operation, tampons were taken out of the acoustic duct and the transplants in 27cases showed normal color and growth. 4 cases had low Blood-supply. 2 cases showed bottom margin crevices. All the transplants were maintained after therapy. The follow-up showed that the tympanums in 28 cases grew well(85% ). Perforation of ear drum recurred in 2 cases 6 months after-wards. 1 case with the transplanted tympanum perforated and suppurated again. The transplant invaginated in 1 case but get better after inflating the eustachian tube. 1 case had relative severe tympanum invaginating and didn't show acoustic sensibility recovery. 1 year after operation, the tympanic membranes of 28 ears were normal. Among 33 ca-ses, the air bone gap in 9 patients was improved 10dB HL. 14 ears were improved from 15 to 20 dB HL, 6 ears were improved from 25 to 30 dB HL. 4 cases showed no change. Conclusion Tympanoplasty can be performed in pa-tients with chronic suppurative otitis media in the period of infection. The complete removal of diseased tissue, pla-cing the transplant precisely, preventing formation of cholesteatoma and restoring the eustachian tube function are key factors to successful operation