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| 題 名 | 修正式鼓室成形術的經驗=Experiences in Revised Tympanoplasty |
|---|---|
| 作 者 | 方德詠; 洪朝明; | 書刊名 | 臺灣耳鼻喉頭頸外科雜誌 |
| 卷 期 | 40:6 民94.11-12 |
| 頁 次 | 頁230-235 |
| 分類號 | 416.821 |
| 關鍵詞 | 修正鼓室成形術; 慢性中耳炎; Revised tympanoplasty; Chronic otitis media; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 背景:鼓室成形術的手術方法雖已漸趨標準化,但仍偶有失敗病例。從修正手術時的術中發現,及術後成果,進而探討手術失敗之原因。 方法:研究對象為1994年11月至2004年7月間,在國泰醫院耳鼻喉科的50名非膽脂瘤病患,其曾在各醫院接受鼓室成形術,但因殘餘鼓膜穿孔、持續耳分泌物或聽力障礙等,而在本院接受修正手術。統計修正手術時的術中發現,及術後追蹤結果。 結果:穿孔位置:中央型23例,前方及前下方12例,後下方4例,幾乎完全穿孔4例,無穿孔7例。術中發現病變:耳道彎曲狹窄16例,外耳道充滿瘢痕組織1例,骨壁裸露1例;鼓膜炎,包括肉芽性或結痂變厚的鼓膜10例,鼓膜塌陷2例;移植片病變共23例,包括掉落9例,壞死6例,前端鈍化5例,側移3例;中耳腔病變35例,包括肉芽組織在面神經隱窩21例,鎚骨周圍4例,廣泛性4例,廣泛性纖維化6例;乳突炎3例。聽小骨正常者35例,缺損10例,固定5例。手術方式:耳道狹窄者作耳道成形術;中耳徹底清除病變,合併乳突切除術3 例;重建聽小骨6例。術後追蹤移植片穩定48例,殘餘鼓膜穿孔2例。 結論:鼓室成形術成功的關鍵,在於術中有良好視野、徹底清除病變、移植片是否完整及植入方式是否恰當。 |
| 英文摘要 | BACKGROUND: Tympanoplasty for simple chronic otitis media had been standardized for decades. However, there were still some cases where the technique fails. Therefore, we have tried to identify the causes of failure after reviewing the operation findings and post-operation results of revised tympanoplasty. METHODS: Fifty chronic non-cholesteatomatous otitis media patients were collected at Cathay General Hospital between Nov, 1994 to Jul, 2004. All of them had received tympanoplasty previously. Because of residual tympanic membrane perforation, persistent otorrhea and hearing impairment, they underwent revised tympanoplasties under local or general anesthesia. The operation findings and their results were analyzed. RESULTS: Of the 50 cases, 23 cases had central perforations, 12 cases had anterior and anterior-inferior perforations, 4 cases had posterior-inferior perforations and 4 cases had subtotal perforations. There were 7 cases without perforation but these had problems of lateralization (3 cases), atelectas is (2 cases) and myringitis (2 cases). The operation findings in all cases were analyzed. Firstly, the external ear canal, which was narrow or tortuous (16 cases), an external ear canal filled with scar tissue (1 case) or bare bone (1 case). Secondly, the tympanic membrane, which showed myringitis (10 cases) or atelectas is (2 cases). Thirdly, the graft, which showed collapse (9 cases), necrosis (6 cases), anterior blunting (5 cases) or lateralization (3 cases). Fourthly, middle ear cavity les ions, which were present in 35 cases and included facial recess granulation (21 cases), granulation around the malleus (4 cases), diffuse granulation (4 cases), and diffuse fibrosis (6 cases). Fifthly, three cases showed mastoiditis. Finally, the ossicles, where 35 cases had normal ossicular chains, 10 cases had ossicular defects and 5 cases had fixed ossicles. Canalplasty was performed in all the cases that showed narrow external ear canals. The facial recess was exposed in order to remove the granulation tissue. In addition to tympanoplasty, three cases received intact canal wall mastoidectomies, and 6 cases underwent ossiculoplasties. Post-operation follow-up showed 48 cases had stable grafts and 2 cases had residual perforations. CONCLUSIONS: The key points for tympanoplasty were preparing a good operation field, totally eradicating the diseased tissue, an intact graft and the correct grafting technique. |
本系統中英文摘要資訊取自各篇刊載內容。