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Миринготомия

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    +7 (812) 363-45-43

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    info@lebedevmed.ru


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Миринготомия


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Миринготомия (парацентез) – это разрез барабанной перепонки для удаления патологического отделяемого из барабанной полости и устранения болевых ощущений. Миринготомию выполняют взрослым и детям, парацентез чаще делают детям. Техника проведения Вмешательство выполняется врачом-отоларингологом под местным обезболиванием у взрослых (обычно это 2% раствор лидокаина), а у детей для выполнения процедуры делают общее обезболивание. Изогнутой иглой рассекают эпидермис (верхний слой барабанной перепонки) и отслаивают его от среднего слоя. Циркулярные волокна среднего слоя разрезают, а радиальные раздвигают микроиглой. Если описанные действия выполнены правильно, миринготомическое отверстие имеет овальную форму. Затем берут металлический крючок (микрораспатор), которым раздвигают края образовавшегося отверстия, чтобы его диаметр соответствовал диаметру вентиляционной трубки. Миринготомия – это начальный этап формирования тимпаностомы, которая представляет собой введение трубки в барабанную полость для улучшения оттока патологического содержимого и сохранения воздушной полости в среднем ухе. Второй способ проведения миринготомии – без иглы, с помощью лазера. После выполнения местной анестезии световод лазера прислоняют к барабанной перепонке в области её задненижнего квадранта. Воздействуют на данный участок барабанной перепонки импульсом лазерного излучения мощностью от 3 до 5 Вт; длиной волны 1,32 мкм; продолжительность воздействия 0,4-0,6 секунд. Первый импульс лазера формирует отверстие в барабанной перепонке, которое соответствует диаметру световода. Образованное отверстие после удаления вентиляционной трубки закрывается самостоятельно. Отверстие диаметром 1 мм может закрыться уже через неделю, 2 мм – через 4 недели, 3 мм сохраняется до полутора лет. Парацентез выполняют детям специальной парацентезной иглой. В месте выбухания барабанной перепонки на всю её толщину выполняют разрез. Уже в начале разреза из барабанной полости начинает выделяться гнойное или серозное содержимое. Но длина разреза должна составлять около трети длины диаметра барабанной перепонки. Слишком маленький разрез препятствует полному выделению патологического содержимого наружу. Удаление отделяемого из барабанной полости осуществляют отсосом. Следует избегать разреза барабанной перепонки в задневерхнем квадранте из-за большой опасности травматизации слуховых косточек. Показания Острый средний отит, предперфоративная стадия (угроза разрыва барабанной перепонки). Наличие экссудата в барабанной полости. Злокачественные новообразования основания черепа (для лазерной миринготомии). Подготовка Общий анализ крови. Общий анализ мочи. Консультация ЛОР-врача, осмотр наружного уха и барабанной перепонки с помощью отоскопа. Проверка слуха. Тимпанометрия. При выполнении общей анестезии последний приём пищи – за 8 часов до манипуляции (накануне вечером), при использовании местного обезболивания нельзя есть за 2-3 часа перед процедурой. Осложнения Кровотечение при повреждении сосудов. Инфицирование раны. Повреждение слуховых косточек и нарушение слуха. Повреждение отделов уха, расположенных перед барабанной перепонкой. Отсутствие эффекта от процедуры, необходимость повторного вмешательства.

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