自体皮质骨外耳道重建在开放式鼓室成形术中的应用  

Clinical application of canal wall reconstruction with homograft cortical bone plate in canal wall down tympanoplasty

作　　者：马喆[1] 习国平[1] 张社江[1] 蔡爱军[1] 郝艳芳[1] 梁宝莲[1] 

机构地区：[1]邯郸市第三医院耳鼻咽喉科,河北邯郸056001

出　　处：《山东大学耳鼻喉眼学报》2012年第1期60-62,共3页Journal of Otolaryngology and Ophthalmology of Shandong University

摘　　要：目的对开放式鼓室成形术中利用自体皮质骨行外耳道重建的方法及疗效进行评价。方法将接受手术治疗的胆脂瘤型中耳炎患者49例(49耳)分为两组。实验组,行开放式鼓室成形术+自体皮质骨外耳道重建术25例(耳);对照组,行常规开放式鼓室成形术+耳甲腔成形术24例(耳)。术后随访6～36个月,观察两组患者术后听力结果、干耳率情况。结果以术后语言频率气骨导差缩小>15 dB或气导听阈<40 dB为有效标准,实验组有效率68%(17/25),对照组有效率62.5%(15/24),组间比较无统计学意义(χ2=0.163 5,P>0.05)。实验组干耳率为92.5%(23/25),明显高于对照组58.33%(14/24),差异有统计学意义(χ2=4.363 6,P<0.05)。实验组重建后的外耳道结构正常,无闭锁或狭窄情况发生。中耳乳突腔均接近正常。全部病例均无胆脂瘤复发。结论开放式鼓室成形术加自体皮质骨外耳道重建术,能有效清除中耳病灶组织、恢复外耳道和中耳的结构,术后听力结果满意,干耳率高,是较为理想的手术方式。Objective To evaluate the therapy of canal wall down tympanoplasty and canal reconstruction with homograft cortical bone plate.Methods Retrospective case review.49 patients were divided into 2 groups.The experimental group that included 25 ears underwent canal wall down tympanoplasty and canal reconstruction with homograft cortical bone plate,while the control group that included 24 ears underwent regular canal wall down tympanoplasty with canal reconstruction.Follow up lasted 6-36 months and postoperative hearing and dry ear rate were evaluated.Results The criteria for success were defined as AB gap closure over 15 dB HL or air conduction threshold less than 40 dB HL（using the mean of 0.5-,1-,and 2-KHz threshold values）.The experimental group′s effective rate was 68%（17/25） and the control group′s was 62.5%（15/24）.No significant difference was found between the two groups（χ2=0.163 5,P0.05）.The dry ear rate of the experimental group was significantly higher than that of the control group（92% vs 58.33%,χ2=4.363 6,P0.05）.Patients of the experimental group showed a normal postoperative external auditory canal without closure or stenosis.Conclusion Canal wall down tympanoplasty and canal reconstruction with homograft cortical bone plate has advantage in retaining the physical structure of external auditory canal and middle ear,with complete removal of lesions and is more efficient in improving hearing and obtaining dry ear.

关 键 词：胆脂瘤 鼓室成形术 外耳道重建 自体皮质骨 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]