保留骨桥的乳突鼓室成形术及软壁外耳道重建治疗胆脂瘤中耳炎  

The treatment of cholesteatoma otitis media by intact-bridge tympanomastoidectomy and soft-wall reconstruction of ear canal

作　　者：阮奕劲[1] 曾薇[2] 朱怀文[1] 薛远琼[1] 肖富新[1] 蔡卓[1] 刘芊[1] 石雄州[1] 

机构地区：[1]广东医学院附属陈星海医院耳鼻咽喉科,广东中山528415 [2]中山大学附属中山医院耳鼻咽喉头颈外科

出　　处：《中国中西医结合耳鼻咽喉科杂志》2012年第4期260-263,共4页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的探讨并评价保留骨桥的乳突鼓室成形术及软壁外耳道重建治疗胆脂瘤中耳炎的临床效果。方法对67例(69耳)胆脂瘤中耳炎患者施行保留骨桥的乳突鼓室成形术(IBM)及软壁外耳道重建,手术开放鼓窦、乳突及上鼓室,切除骨性外耳道后壁,经面隐窝开放后鼓室,完全清理不可逆病变,为保持中耳腔容积,保留低位骨桥;同时应用带蒂耳后肌骨膜瓣-外耳道皮瓣复合瓣填充乳突术腔并重建了外耳道,并同期或分期行鼓室成形术。结果随访24个月以上,干耳时间16～35d(平均23.1±3.4d),语频区气骨导差平均缩小(25.3±6.7)dB HL,术后基本恢复了外耳道的解剖形态及正常生理功能。结论 IBM手术及软壁外耳道重建在根除病灶的基础上保存或提高了听力,并恢复了外耳道基本形态及功能,为治疗胆脂瘤中耳炎较佳的选择。Objective To investigate and estimate the clinical effect of the treatment of cholesteatoma otitis media by intact-bridge tympanomastoidectomy （IBM） and soft-wall reconstruction of ear canal. Methods 67 otitis media patients （69 ears） with cholesteatoma who underwent modified IBM and soft-wall reconstruction of ear canal were enrolled in this study. The operation process included opening the tympanic sinus, the mastoid and the attic, also excising the ostesl posterior wall of the external acoustic meatus, and then opening the back tympanum through the facial recess, clearing the inconvertible pathology completely. In order to maintain the volume of the middle ear canals, the infraversion bridge should be retained. Meanwhile, filling up the operative lacuna with combined flaps of postauricular musculo-periosteal and canal skin flap, and reconstructing external acoustic meatus were conducted. A tympanoplasty was performed at the same or different period. Results The patients were followed up for more than 24 months, and the dry ear time was 16-35 days （23.1±3.4d on average）. The air-bone conduction gap was reduced by （25.3±6.7）dB HL on average. The anatomic form and physiologic function of the external acoustic meatus were recovered basically. Conclusions： The IBM and soft-wall reconstruction of ear canal could remain or improve the hearing and recover the basis morphology and function of ear canal. This method could be a better choice for treating the cholesteatoma otitis media.

关 键 词：胆脂瘤中耳炎 鼓室成形术 耳外科手术 外科皮瓣 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]