摘要目的 分析胆脂瘤性中耳乳突炎的保留骨桥式乳突鼓室成形术(intact-bridge tympanomastoidectomy,IBM)术中面神经隐窝开放技术及其临床应用和远期治疗效果.方法 回顾性分析2000至2003年随访3年以上的63例(65耳)IBM术中开放面神经隐窝治疗的脂瘤性中耳炎病例的临床资料及随访结果 .在保留低位骨桥的解剖关系下,仍能安全开放面神经隐窝,有效清除后鼓室区域的隐匿病灶.结果 本组术后干耳时间4～13周,平均6.2周.62耳术后乳突腔上皮化良好,移植鼓膜愈合,干耳率95%(59/65).3耳耳漏及2耳胆脂瘤珠残留,经再次手术愈合.术后气骨导间距缩小值＞10 dB 60耳;平均语言频率气导听阈提高值为(18.5±7.3)dB.结论 基于术前颞骨高分辨CT,结合术中所见,在IBM手术中应用面神经隐窝开放技术,适用于后鼓室区域的探查与病灶清除,有助于减少术中残留和术后复发、提高远期效果.

abstractsObjective To introduce and evaluate the application of facial recess approach in modified intact-bridge tympanomastoidectomy(IBM) procedures for cholesteatoma otitis media and improve the surgery results and living quality of patients following the operation of tympanomastoidectomy.Methods Sixty-five cases of tympanomastoidectomy for cholesteatoma otitis media followed for more than 3 years between 2000 -2003 were retrospective analyzed.The long-term results of recurrence and hearing level ofreceived modified IBM, there were sixty ears improvedResults In total sixty-five ears IBM were discussed.hearing level ( threshold improved＞10 dB), and the pure-tone average threshold improved by ( 18.5±7.3 ) dB after operation and the dry ear was obtained in 60 cases(95% ).Conclusions With the modified IBM technique, cholesteatoma could be completely and safely removed from the middle ear, and a durable reconstruction of the middle ear with reasonable hearing could be achieved.Therefore, the modified IBM technique was a reasonable choice for the surgical treatment of cholesteatoma otitis media.