廖天义　陈翠芳　周轶

【摘要】 目的：观察改良乳突根治术并Ⅰ期人工听骨植入听力重建术治疗中耳胆脂瘤的临床疗效。方法：选取本院2012年1月-2015年10月收治44例中耳胆脂瘤患者作为研究对象，随机分为研究组和对照组，每组各22例。研究组患者采取改良乳突根治术并Ⅰ期人工听骨植入听力重建术治疗，对照组患者采取单纯的乳突根治术治疗，比较两组患者的临床疗效。结果：术后随访1年，与对照组患者比较，研究组患者的气导平均听阈降低，气骨导差显著缩小，听力明显提高（P<0.05）。研究组患者3例听力没有改善，治疗总有效率为86.4%；对照组患者7例听力没有改善，治疗总有效率为68.2%，研究组的治疗效果明显优于对照组（ 字2=13.85，P<0.05）。研究组患者并发症发生3例（13.6%），1例因人工听骨顶穿移植鼓膜再次手术，2例患者出现继发性外耳道感染。对照组患者中并发症7例（31.9%），6例出现继发性感染，研究组患者的并发症发生率明显低于对照组（P<0.05）。研究组无胆脂瘤復发病例，对照组3例患者胆脂瘤复发。结论：改良乳突根治术并Ⅰ期人工听骨植入听力重建术治疗中耳胆脂瘤患者，临床疗效显著，提高听力，并发症少，复发率低，值得临床推广应用。

【关键词】 中耳胆脂瘤； 改良乳突根治术； 人工听骨植入

【Abstract】 Objective：To observe the efficacy of modified radical mastoidectomy and Ⅰ stage artificial ossicular implants for hearing reconstruction with middle ear cholesteatoma.Method：44 patients with middle ear cholesteatoma were enrolled in our hospital from January 2012 to October 2015，they were randomly divided into study group and control group，22 cases in each group.The patients in the study group were treated with modified radical mastoidectomy and I stage artificial ossicular implants for hearing reconstruction.The patients in the control group were treated with mastoidectomy.The clinical curative effects of two groups were compared.Result：Follow-up for one year after operation，compared with the control group，the average air conduction threshold and air bone gap were significantly reduced，hearing was significantly improved in the study group（P<0.05）.3 patients in the study group with no improvement in hearing，the total effective rate of hearing was 86.4%.7 patients with no improvement in hearing in the control group and the total effective rate of hearing was 68.2%.The treatment effect of the study group was significantly better than that of the control group （字2=13.85，P<0.05）.3 cases （13.6%）of complications in the study group ，1 case with artificial ossicle top transtympanic reoperation，2 cases of secondary external auditory canal infection；in the control group， 7 cases （31.9%）of complications，6 cases of secondary infection.The incidence of complications in the study group was significantly lower than that of control group （P<0.05）.The study group had no recurrence of cholesteatoma cases，3 patients of the control group with recurrent cholesteatoma.Conclusion：Modified radical mastoidectomy and Ⅰ stage artificial ossicular implants for hearing reconstruction in the treatment with middle ear cholesteatoma is significant in clinical efficacy，the improvement of hearing， fewer complications， low recurrence rate，and worthy of clinical application.

【Key words】 Middle ear cholesteatoma； Modified radical mastoidectomy； Artificial ossicular implantation

First-authors address：Peoples Hospital of Qingyuan City，Qingyuan 511518，China

doi：10.3969/j.issn.1674-4985.2017.04.035

胆脂瘤中耳炎是耳科较危险的疾病之一，属于慢性化脓性中耳炎[1]。胆脂瘤中耳炎是由于鳞状上皮组织在中耳、乳突内过度生长，脱落上皮不断堆集积累，不断地向四周扩张，从而造成邻近的骨质破坏，产生炎症反应，并引起周围器官的并发症[2]，患者临床表现主要为听力下降、耳流脓、耳鸣等。手术是治疗中耳胆脂瘤的常用方法，而手术中完全清除中耳乳突病变实现干耳，防止颅内外并发症和复发是治疗的关键[3]。因此本院选取2012年

1月-2015年10月44例膽脂瘤中耳炎患者作为研究对象，采用改良乳突根治术并Ⅰ期人工听骨植入听力重建术进行治疗，取得了良好的治疗效果，现报道如下。

1 资料与方法

1.1 一般资料 选取本院2012年1月-2015年10月的44例中耳胆脂瘤患者作为研究对象，均为单侧患病，表现为反复性流脓、听力下降等，均经纯音测听、耳镜及颞骨CT检测确诊[4]。……