CAJ | 학술논문

目的：探讨经典Wullstein Ⅲ型鼓室成形术在慢性化脓性中耳炎手术中的适应证及其术后听力效果。方法回顾性分析行开放式Ⅲ型鼓室成形术的患者34例（34耳），患者均有听骨链破坏而镫骨结构完整，鼓膜内陷与镫骨头或砧骨豆状突直接连接，根据术中是否植入钛合金部分人工听骨（partial ossicular replacement prosthesis，PORP）分为两组， Wullstein Ⅲ型鼓室成形术（Ⅲ型组）11例和植入钛合金部分人工听骨(PORP组)23例。分别比较两组术后0.5、1、2和4 kHz的平均气导听阈、平均气骨导差的变化情况。结果Ⅲ型组患者术前平均气导听阈为46.59±16.60 dB HL，术后为34.89±10.34 dB HL,气导听阈提高11.70±19.30 dB HL；PORP组术前平均气导听阈为44.23±12.31 dB HL，术后为37.08±14.36 dB HL，提高7.14±14.39 dB HL；Ⅲ型组术前平均气骨导差（air-bone gap，ABG）为23.98±13.08 dB HL，术后为16.25±6.98 dB HL，缩小7.73±14.93 dB HL；PORP型组术前平均ABG为26.58±10.27 dB HL，术后为19.40±13.28 dB HL，缩小7.17±13.63 dB HL。两组患者在气导听阈提高值及ABG缩小的差异均无显著统计学意义（P>0.05）。结论开放式鼓室成形术中，如果鼓膜内陷与镫骨头或砧骨豆状突形成连接，可以予以保留，短期随访术后听力水平与植入PORP重建听骨链的效果相当，长期效果还需随访观察。
목적：탐토경전Wullstein Ⅲ형고실성형술재만성화농성중이염수술중적괄응증급기술후은력효과。방법회고성분석행개방식Ⅲ형고실성형술적환자34례（34이），환자균유은골련파배이등골결구완정，고막내함여등골두혹침골두상돌직접련접，근거술중시부식입태합금부분인공은골（partial ossicular replacement prosthesis，PORP）분위량조， Wullstein Ⅲ형고실성형술（Ⅲ형조）11례화식입태합금부분인공은골(PORP조)23례。분별비교량조술후0.5、1、2화4 kHz적평균기도은역、평균기골도차적변화정황。결과Ⅲ형조환자술전평균기도은역위46.59±16.60 dB HL，술후위34.89±10.34 dB HL,기도은역제고11.70±19.30 dB HL；PORP조술전평균기도은역위44.23±12.31 dB HL，술후위37.08±14.36 dB HL，제고7.14±14.39 dB HL；Ⅲ형조술전평균기골도차（air-bone gap，ABG）위23.98±13.08 dB HL，술후위16.25±6.98 dB HL，축소7.73±14.93 dB HL；PORP형조술전평균ABG위26.58±10.27 dB HL，술후위19.40±13.28 dB HL，축소7.17±13.63 dB HL。량조환자재기도은역제고치급ABG축소적차이균무현저통계학의의（P>0.05）。결론개방식고실성형술중，여과고막내함여등골두혹침골두상돌형성련접，가이여이보류，단기수방술후은력수평여식입PORP중건은골련적효과상당，장기효과환수수방관찰。
Objective To explore the indication and efficacy of Wullstein typeⅢtympanoplasty in treating the patients with chronic suppurative otitis media. Methods Thirty-four patients (34 ears)were studied who underwent canal wall-down tympanoplasty retrospectively. In all patients, ossicular chain destructions were confirmed during the operation while stapes kept intact with good mobility. The patients were divided into two groups according to the reception of partial ossicular replacement prosthesis (PORP). 11 cases underwent type Ⅲ tympanoplasty (type Ⅲ group) and 23 cases received PORP (PORP group). The average postoperative air-conduction thresholds and air-bone gaps (ABG) were measured and compared at 0.5, 1, 2 and 4 kHz. Results The preoperative air-conduction thresholds for type Ⅲ and PROP groups were 46.59±16.60 dB HL and 44.23±12.31 dB HL, respectively. The postoperative air-conduction thresholds for type Ⅲ and PROP groups were 34.89±10.34 dB HL and 37.08±14.36 dB HL, and the increments of the air-conduction thresholds after the surgery were 11.70±19.30 dB HL and 7.14±14.39 dB HL, respectively. The ABG changes of typeⅢgroup were 7.73±14.93 dB HL, and for PORP group were 7.17±13.63 dB HL before and after the surgery. There was no statistically significant difference between the two groups in the increment of air-conduction thresholds and ABG changes (P>0.05). Conclusion The myringostapediopexy or myringolenticulopexy can be reserved in the wall-down tympanoplasty for it showed equal efficacy in hearing reconstruction with PORP. Meanwhile, further observations are needed for long term outcomes.