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題名 | 經耳道式中耳手術之初步經驗=Preliminary Experience of Transcanal Middle Ear Surgery |
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作 者 | 周大元; 賴仁淙; | 書刊名 | 中華民國耳鼻喉科醫學會雜誌 |
卷期 | 33:2 1998.04[民87.04] |
頁次 | 頁49-54 |
分類號 | 416.81 |
關鍵詞 | 經耳道式; 鼓室成形術; 聽小骨成形術; Transcanal; Tympanoplasty; Ossiculoplasty; |
語文 | 中文(Chinese) |
中文摘要 | 背景:探討中耳手術中,以「經耳道式」(transcanal)徑路,施行鼓室成形術與聽 小骨成形術之適用性與治療成果。 方法:收集本科自民國85年4月至民國86年3月間,施行中耳手術之案例中,採行「經 耳道式」徑路之鼓室成形術與聽小骨成形術者,探討其治療成果(鼓膜補妥及聽力進步), 以及可能影響癒後之變數。 結果:60例「經耳道式」鼓室成形術患者,術後門診追蹤1至6個月,鼓膜補妥者52 例,仍有殘餘破洞者8例。其中初次接受手術者39例,術後鼓膜補妥者38例,占97.4%; 接受再次手術者21例,術後鼓膜補妥者14例,占66.7%。此60例病患中,行鼓膜耳道皮 瓣切開步驟者17例,未行此步驟者43例。「經耳道式」聽小骨成形術患者13例,其中11 例術後聽力進步(85%),平均之氣骨導差間距進步14dB。 結論:行鼓室成形術病患中,鼓膜破損位置愈前緣,手術成功率愈低(p=0.031)。初次 接受手術者較再次手術者之手術成功率高(p=0.001)。是否併行鼓膜耳道皮瓣(tympanomeatal flap)切開步驟,亦會影響手術成功率(p=0.009)。「經耳道式」徑路中耳手術是一種安全、 經濟、有效且兼顧美觀的手術方式,但須選擇適合的病例,輔以純熟的顯微鏡下操作經驗, 才可得到好的治療成果。(中耳醫誌 1998; 33:148-152。) |
英文摘要 | Background: The purpose of this study is to discuss the indications and therapeutic results of transcanal approach tympanoplasty and ossiculoplasty. Methods: The selected samples of transcanal tympanlplasty and ossiculoplasty were collected from our surgical cases of middle ear disorders from Apr. 96' to Mar. 97'. We will discuss the therapeutic results (graft taken and hearing improved) and the variances which could influence their prognosis. Results: During 1 to 6 months of regular outpatient follow up after operation, of all the 60 cases of transcanal tympanoplasty, the tympanic membrane was intact in 52 cases of them, and the other 8 cases remained perforated. Thirty nine of the 60 cases were fresh cases and 38 (97.4%) of the 39 cases had graft taken after operation; the other 21 cases were revised cases and only 14 (66.7%) of them had graft taken after operation. Of all the 13 cases of transcanal ossiculoplasty, 11 cases (85%) had hearing improved after operation, the average air-bone gap improved 14 dB. Conclusions: For those who received tympanoplasty, the more anteriorly perforated tympanic membrane, the lower its success rate (Chi-square, p=0.031). The success rate of fresh tympanoplasty is higher than that of revised cases (Chi-square, p=0.001), and those combined with tympanomeatal flap elevation will also increase it's success rate (Chi-square, p=0.009). Middle ear surgery by transcanal approach is a kind of safe, economic, effective and cosmetic surgical method. But only the careful cases selection before operation and operating with skillful and experienced microscopic technique could insure the satisfied therapeutic results. |
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