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| 題 名 | 矽膠片使用於中耳手術=Silicone Sheeting in Middle Ear Surgery |
|---|---|
| 作 者 | 李景徽; 李易倉; | 書刊名 | 中華民國耳鼻喉科醫學雜誌 |
| 卷 期 | 34:4 民88.07-08 |
| 頁 次 | 頁276-280 |
| 分類號 | 416.821 |
| 關鍵詞 | 中耳手術; 矽膠片; Middle ear surgery; Silicon sheeting; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 背景:中耳手術之主要目的為重建聽力。因此,如何經由手術建立一個黏膜完整 、通氣絕佳且聽小骨振動良好之中耳腔,手術者追求的目標。本文將討論於中耳手術中,由 不同型式之矽膠片設計,所導致不同之手術結果。方法:自 1989 年 1 月至 1995 年 1 月 接受中耳手術的病人中,有 115 名病人於術中置入矽膠片。 其中男性病人有 49 名,女性 有 66 名。病患年齡自 19 至 68 歲不等,平均年齡 47.2 歲。使用矽膠片之厚度、大小及 型式,乃根據術中所見病人中耳腔情況而定:矽膠片的大小及形狀以能夠完全覆蓋受損黏膜 之區域為原則。同時視病人中耳腔之深淺選用不同厚度之矽膠片,以免太薄太軟的矽膠片容 易移位或捲曲;或是太厚之矽膠片佔據太多中耳容積,甚至於太貼近鼓膜因而限制鼓膜振動 。 病人於術後返回門診追蹤其預後情形,以期尋找出最佳型式之矽膠片設計。 結果:共有 92 名病人於術後門診追蹤達半年至 2 年之久 (平均追蹤時間 13 個月 ), 有 68 名 (73.9%) 患者復原良好; 另有 24 名 (26.1%) 病人發生不同情形之併發症:包括術後發生 鼓室積血 2 名 (佔術後併發症 8.3%):發生耳鳴有 4 名 (佔 16.67%):鼓膜再度穿孔有 2 名 (8.33%);發生術後再沾粘有 14 耳 (58.33%) 及聽力未見改善者 2 名 (8.33%)。 我們 檢討術後併發生原因發現:矽膠片的大小及置放位置不當,或是形狀及厚度不當,均是造成 術後併發症發生的原因。我們分析不同病人其所產生的併發症,並且尋求其解決之道。結論 :矽膠片使用於中耳手術中由來已久,其可以有效預防術後中耳組織再沾粘的發生,然而設 計不當之矽膠片反而容易導致中耳問題之再發。因此,如何經由更精確之設計,以獲得最大 之效益,並避免發生併發症,便是本研究之主要目的。 |
| 英文摘要 | Background:Hearing restoration is the major goal in middle ear surgery. To obtain this objective, an air-filled and mucosa-lined middle ear space with satisfactorily mobile ossicles should be reconstructed. In this study we evaluated the effect of silicone sheeting on the condition of the middle ear following tympanoplasty. Methods: From January 1989 through January 1995, 115 patients with adhesive otitis media underwent tympanoplasty with the use of silicone sheeting. There were 49 men and 66 women. Their ages ranged from 19 to 68 with a mean age of 47.2 years. The dimensions of the sheeting were decided according to the condition of the middle ear. The patients were followed postoperatively and side effects resulting from the silicone sheeting were recorded. Results: Ninty-two patients were followed for 6 to 24 months (average : 13 months). Sixty-eight patients (73.9%) completely recovered. However, various side effects were noted postoperatively in 24 patients (26.1%): hemotympanum, 2/24 (8.33%). tinnitus, 4/24(16.6%); ear drum reperforation, 2/24(8.33%); redhesion of the middle ear, 14/24 (58.33%);and no improvement in hearing, 2/24(8.33%). Malposition, poor fixation, and inadequate dimensions of the sheeting may have been responsible. We evaluated these possibilities and managed to solve the problems. Conclusions: Silicone sheeting has been used in middle ear surgery for a long time. It is intended to prevent postoperative readhesion of the middle ear and to enhance successful reconstruction. However, and inadequate design will cause untoward effects. Thus, designing adequate silicone sheeting to get maximum benefits and prevent side effects is effects is of prime importance. |
本系統中英文摘要資訊取自各篇刊載內容。