CAJ | 학술논문

目的探讨在保持外耳道后壁完整的情况下，切除上鼓室外侧壁并软骨封闭治疗中耳胆脂瘤的疗效。方法2009年11月～2012年7月对123例（123耳）中耳胆脂瘤患者行保留外耳道后壁的乳突切开、上鼓室盾板切除及面神经隐窝向上鼓室开放，清除病变后行上鼓室软骨封闭及乳突腔填塞术，术后随访6～38个月，观察胆脂瘤复发、上鼓室回缩袋形成情况及听力提高水平，分析其疗效。结果123例中，2例中耳腔胆脂瘤复发，6例术后耳后切口感染，3例鼓膜边缘穿孔延迟愈合，2例人工听骨脱出，4例术后耳道后壁肿胀或皮肤缺损，其余病例术后换药2～3次后鼓膜、外耳道形态恢复，痊愈时间1个月。听力资料完整的83例（67．5％，83/123）中，0．5、1、2 kHz气骨导差术前平均32．2±11．25 dB ，术后平均20．69±12．41 dB ，手术前后气骨导差缩小11．59±10．1 dB（P＜0．001）。结论乳突切开同时保留外耳道后壁使耳道形态得以保留，术后恢复时间短；切除上鼓室外侧壁能够更充分暴露病变，病灶清除彻底；上鼓室外侧壁软骨封闭重建可有效防止回缩袋的形成，避免胆脂瘤复发。
목적탐토재보지외이도후벽완정적정황하，절제상고실외측벽병연골봉폐치료중이담지류적료효。방법2009년11월～2012년7월대123례（123이）중이담지류환자행보류외이도후벽적유돌절개、상고실순판절제급면신경은와향상고실개방，청제병변후행상고실연골봉폐급유돌강전새술，술후수방6～38개월，관찰담지류복발、상고실회축대형성정황급은력제고수평，분석기료효。결과123례중，2례중이강담지류복발，6례술후이후절구감염，3례고막변연천공연지유합，2례인공은골탈출，4례술후이도후벽종창혹피부결손，기여병례술후환약2～3차후고막、외이도형태회복，전유시간1개월。은력자료완정적83례（67．5％，83/123）중，0．5、1、2 kHz기골도차술전평균32．2±11．25 dB ，술후평균20．69±12．41 dB ，수술전후기골도차축소11．59±10．1 dB（P＜0．001）。결론유돌절개동시보류외이도후벽사이도형태득이보류，술후회복시간단；절제상고실외측벽능구경충분폭로병변，병조청제철저；상고실외측벽연골봉폐중건가유효방지회축대적형성，피면담지류복발。
Objective To report the curative effect of the epitympanoplasty with cartilage obliteration in the treatment of middle ear cholesteatoma .Methods This study retrospectively analysed 123 cases ,with middle ear cholesteatoma treated in our department from November 2009 to July 2012 .The operation included mastoidectomy with posterior canal wall preserved ,lateral wall of attic resected ,facial recess opened to the epitympanum ,epitym-panum obliterated with cartilage and mastoid cavity blocked with bone dust .All cases were followed up on complica-tions and hearing improvement .Results All cases were followed up 6~38 months .In 123 cases ,there were 2 ca-ses had cholesteatoma recurrence in the middle ear cavity ,6 cases had infection of post auricular incision after opera-tion ,3 cases had residual marginal tympanic membrane perforation ,2 cases had ossicular replacement prosthesis ex-clusion ,and 6 cases had canal wall skin swelling or defect .The rest cases acquired full -recovery after 2 or 3 wound dressing changes .Out of 123 cases ,83 cases had the whole hearing document ,the average AB gap at 0 .5 ,1 ,2 kHz reduced from 32 .2 ± 11 .2 dB pre-operation to 20 .7 ± 12 .4 dB post -operation .The AB gap of pre - and post -operation had significant difference (P<0 .001) .Conclusion The mastoidectomy with posterior canal wall preserved greatly shortened the healing time .The resection of lateral wall of epitympanum can exposed operating field more completely and remove lesions thoroughly .The cartilage obliteration in the attic can prevent the retraction pocket formation effectively .This technique provides alternative in treating middle ear cholesteatoma .