耳内镜下软骨填塞上鼓室在胆脂瘤手术中的临床应用

Clinical application of otoendoscopic tympanic cartilage packing in cholesteatoma surgery

摘要:

目的 探讨耳内镜下软骨填塞上鼓室在胆脂瘤手术中的治疗效果。方法 收集2019年1月—2023年1月经手术治疗的26例(26耳)胆脂瘤患者，所有患者上鼓室均受侵犯，彻底清除上鼓室胆脂瘤，并应用软骨(耳屏、耳甲腔或鼻中隔软骨)填塞上鼓室。术后6个月复查耳内镜、纯音听阈；术后1年复查耳内镜。结果 术前气导纯音听阈测定为(41.25±2.39)dB HL，术后6个月复查为(26.32±4.34)dB HL；骨导纯音听阈测定术前为(26.45±5.39)dB HL，术后6个月为(12.69±6.43) dB HL；术后6个月复查所有患者均未出现上鼓室外侧壁内陷，无胆脂瘤复发；术后1年复查，1例出现内陷，胆脂瘤复发(1/26，3.85%)。结论 采用软骨进行上鼓室填塞可有效预防上鼓室外侧的内陷，减少胆脂瘤的复发，术后听力改善良好。

Abstract:

Objective To investigate the efficacy of endoscopic cartilage packing in the cholesteatoma treatment. Methods A total of twenty-six patients (26 ears) with cholesteatoma who underwent surgery from January 2019 to January 2023 were collected. The invaded epitympanic cholesteatoma in all patients was completely removed, and the epitympanic was filled with cartilage (tragus, concha cavity or nasal septum cartilage). The endoscopic examination and pure tone audiometry were reexamined at 6 months after operation. One year after operation, otoendoscopy was performed. Results The pure tone air conduction threshold audiometry was (41.25±2.39)dB HLbefore operation, which was (26.32±4.34)dB HL 6 months after operation. The pure tone bone conduction threshold audiometry was (26.45±5.39)dB HL before operation and (12.69±6.43)dB HL 6 months after operation. In all patients, there was no invagination of the lateral wall of the attic, and no recurrence of cholesteatoma six months after operation. One year after operation, 1 case had invagination and recurrence of cholesteatoma 1/26(3.85%). Conclusion Cartilage packing can effectively prevent the invagination of the lateral wall of the attic, reduce the recurrence of cholesteatoma, and improve the hearing after operation.