鼓室成形術的關鍵

Pitfalls in Tympanoplasty

洪朝明(Chao-Ming Hung)

《台灣耳鼻喉頭頸外科雜誌》 39卷s_1期 (2004/01) Pp. 32-36

https://doi.org/10.6286/2004.39.s_1.32

摘要

鼓室成形術的目標為:清除病變、修補鼓膜、及增進聽力。妥善的術前準備、選擇適合的麻醉方法、細心精準的手術及術後定期的追蹤治療為成功的要件。術者必須注意下列要點才能避免手術失敗：1)面神經隱窩是最常被忽視的病變隱藏處，刮除覆蓋鼓索神經的部分骨壁到可明視砧鐙關節的程度，即可移除該處病變。2)術中出血可用浸泡腎上腺素的 Gelfoam 壓迫，軟組織則用雙極電刀，但切忌在外耳道用電燒止血.3)突出的外耳道壁要用到刮匙刮平或鑽頭磨平，以求視野無礙。4)如果破洞接近或超過鼓室環，置放筋膜應採夾層法。5)在筋膜前方剪一條切口，槌骨柄由此穿出，再將切口兩側拉高覆蓋槌骨頸，可防止術後鼓膜塌陷或外移。6)儘可能移除槌骨柄前方及鼓膜中層的鼓室硬化瘢。如果槌骨及砧骨都已僵化而鐙骨仍可動，則以短柱(short columella)重建。如果槌骨柄與鼓室內壁沾粘，則剪斷部分槌骨柄，鼓室再墊以Gelfilm或薄矽膠片。7)中耳腔病變較嚴重者，聽小骨重建最好留待第二階段再實施。8)術中嚴守無菌觀念、避免製造壞死組織，以減少術後感染，將可降低術後再破損的機會。7歲以下的兒童除非急迫需要或含併發症者，儘量延後手術年齡。年老(大於75歲)、體弱或合併其他全身性疾病者，也不宜手術。

關鍵字

慢性中耳炎 ； 手術技巧

並列摘要

The aims of tympanoplasty are to eradicate disease, to repair the drum, and to restore hearing. The prerequisite of a successful surgery requires: proper pre-operative evaluation, good anesthesia, meticulous and precise surgery and regular postoperative follow-up. Surgeons have to pay attentions to the followings: 1. The pathologic tissue in the facial recess is usually neglected, and can be removed after the bony wall covering the chorda tympani nerve has been removed to the point enough to visualize the I-S joint. 2. Epinephrine-soaked Gelform is good enough for minor bleedings, and the bleeders in soft tissue should be controlled with bipolar cauterization. Cauterization to the canal bony wall is prohibited. 3. All bony overhangs in the canal should be eliminated for a better visual field. 4. If the anterior margin of the perforation is near or extended the annulus, the sandwich method is the choice for grafting. 5. To prevent atelectasis or lateralization, make a slit at the anterior third, and place the graft under the malleus handle, then wrap the neck of malleus neck with both limbs of the slit. Cartilage may also enforce the posterior part of drum. 6. In the presence of mobile stapes, fixed incus and malleus, reconstruct with short columella. If the malleus manubrium adhered to the promontory wall, cut part of the handle and put sheeting with thin with Silastic or Gelfilm. 7. Stage the surgery for hearing restoration on patients with severe mucosal disease or fixed stapes. 8. Strictly follow the antiseptic rules and do not make necrotic tissue during the operation will reduce the chances of postoperative infection and reperforation. 9. Children younger than 7 years of age and the elders older than 75 years are not good candidates for operation.

並列關鍵字

tympanoplasty ； surgical technigue