Z形皮瓣法和乳突外耳道联合径路在先天性外耳中耳畸形听力重建中的应用及意义  

Z-flap with combined surgical approach for hearing reconsctruction on congenital external and middle ear malformation

作　　者：钟诚[1] 袁伟[1] 张学渊[1] 陈小宏[1] 姜振东[1] 李琪[1] 向召兰[1] 冯亚瑾[1] 李太军[1] 魏运军[1] 

机构地区：[1]第三军医大学第一附属医院耳鼻咽喉头颈外科,重庆400038

出　　处：《中华耳科学杂志》2010年第3期262-267,共6页Chinese Journal of Otology

摘　　要：目的探讨一种改良的经乳突外耳道联合径路、采用1期转蒂Z形皮瓣结合2期植皮法在先天性外耳中耳畸形中的听力重建效果。方法 2001年3月至2010年1月间,110例确诊为先天性外耳中耳畸形病例,分为纵行切口组(24例)和Z形皮瓣组(86例)。所有病例按Schuknecht畸形分型,经乳突外耳道联合径路,根据术中听骨链情况行Ⅰ-Ⅲ型鼓室成形术。比较两组术前的畸形分型、听力结果、鼓室成形术式;并对两组近期、远期听力学效果及并发症发生率进行比较。结果与纵行切口组比较,Z形皮瓣组术前听力水平、畸形分型与乳突气化分类差异无显著意义(P>0.05)。术后近期听力,无论提高10dBHL以上或提高30dBHL以上,纵形切口组与Z形皮瓣组的近期听力效果差异均无显著意义(P>0.05);但远期听力效果两组差异均有显著意义(P<0.05);Z型皮瓣组的近期与远期听力效果差异无显著意义(P>0.05)。两组并发症发生率差异有显著意义(P<0.05)。结论术前详尽的耳畸形程度判定、术中对有效中耳传音结构的最大程度保护及经乳突外耳道联合径路、1期转带蒂Z形皮瓣结合2期植皮法具有良好优势,能结合其它方法的优点,在经过合理选择的病例中联合应用,获得较好的远期听力重建效果。Objective To evaluate a modified surgical method for hearing reconsctruction on congenital external and middle ear malformation （congenital aural atresia） including transmastoid-external ear canal combined surgical ap-proach, and a pedicled skin Z flap as well as second stage skingrafting. Methods During March 2001 to January 2010, 110 patients with the diagnosis of congenital aural atresia were classified to two groups： the portait incision group （24 cases） and Z-flap group （86 cases）, they were classified into diffrent Schuknecht types, accepted alternated tmpanoplasty according to their ossicular chain developments. Data were also analyzed to compare the differences of short-term, long-term hearing results and complications between two groups. Results The differences of preoperative hearing loss, chuknecht type, et al had no significance （P 0.05）. There were no significant difference between two groups on short-term hearing results postoperatively, no mater it increased over 10 dB HL or 30 dB HL （P 0.05）; on the contrary, the long-term hearing results had （P 0.05）; and it was noticed that the difference within the Z-flap group wasn’t signifi-cance between short and long-term hearing results （P 0.05）. Further, the incidence rate of postoperative complications differed significantly （P 0.05）. Conclusions With application of the modified surgical strategy mentioned above , as well as individualized preoperative assessments and delicately intraoperative protection of hearing conduct structures of middle ear decreased severe complications and retain a well accepted long-term hearing endins for the congenital aural atresia.

关 键 词：耳畸形 联合径路 Z形皮瓣 听力重建 并发症 

分 类 号：R764.7[医药卫生—耳鼻咽喉科]