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摘要: 目的 总结耳内镜下中耳手术中建立中耳通气引流的经验。方法 回顾性分析我科2016-2018年间收治的耳内镜下实施中耳手术的患者资料, 对其手术中进行中耳通气引流重建的方法进行了总结。结果 收集耳内镜下中耳手术患者共296例(300耳), 其中涉及咽鼓管处理者46例, 涉及中上鼓室引流处理者241例, 涉及中耳含气腔重建者185例。结论 随着内镜技术在耳科应用的不断扩展和耳科医生对手术理念及中耳生理功能认识的不断深入, 利用耳内镜在实现微创的前提下, 可以更加精准地实现和重建中耳通气和引流的功能。Abstract: Objective To summarize the experience of establishing middle ear ventilation in endoscopic middle ear surgery.Method A retrospective analysis was performed on the patients who have received a middle ear endoscopic surgery in our department from 2016 to 2018. The method of reconstructing middle ear ventilation was summarized.Result A total of 300 ears from 296 paitents were collected. Fourty six of the 300 patients had eustachian tube problems, 241 had problems of ventilation between epitympanum and mesotympanum, and 185 had need of ventilation cavity reconstruction.Conclusion With the continuous expansile application of endoscopic technology in the ear surgery and the deepening understanding of otologists on both the surgical concept and the physiological function of the middle ear, the use of endoscopy can achieve the goal of removing lesions accurately and preserving or reconstructing the function on the premise of minimally invasion.
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图 6 左侧中耳鼓室手术，术中保留听骨原位和其连续性、重建前、后鼓峡通气途径 6a：鼓膜内陷，中上鼓室间的通气途径—前、后鼓峡处被肉芽及纤维组织所分隔和阻塞；6b：内镜下清除前、后鼓峡间的肉芽和纤维组织，并小心保护好听骨链的联动状态；6c：内镜下中耳功能性手术可以恢复中耳的通气功能，并兼顾听力功能；图 7 左侧中耳鼓室手术，术中剪掉锤骨头或截除部分锤骨柄末端增加通气 7a：鼓膜内陷，中上鼓室间的通气途径—前、后鼓峡处完全被肉芽组织所阻塞，砧镫关节整体被肉芽组织包裹；7b：内镜下需要取出镫骨，可见上鼓室内胆固醇结晶从上鼓室空间溢出；7c：取出砧骨，将镫骨完全从肉芽组织中松解后，恢复中、上鼓室间稳定的通气途径；图 8 右侧耳内镜下联合入路进行中耳胆脂瘤手术病例 8a：耳内镜下通过鼓窦入口，可以完全直视下处理上鼓室、鼓窦内胆脂瘤病变，注意保护好鼓窦内侧壁的黏膜完整性；8b：通过磨除颧弓根处的骨质，增加内镜操作空间，减少内侧壁骨质和黏膜的损伤。
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