致外耳道狭窄的单骨型颞骨骨纤维异常增殖症手术疗效分析  

Surgical treatment for monostotic fibrous dysplasia of temporal bone with external auditory canal stenosis

作　　者：陈秋坚[1] 杨海弟[1] 郑亿庆[1] 龚坚[1] 

机构地区：[1]中山大学孙逸仙纪念医院耳鼻咽喉科,广东广州510120

出　　处：《中国耳鼻咽喉头颈外科》2012年第9期481-483,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：广东省医学科研基金资助项目(A2011174)

摘　　要：目的回顾性分析单骨型颞骨骨纤维异常增殖症导致外耳道狭窄病例手术治疗的效果。方法对我科确诊为单骨型颞骨骨纤维异常增殖症引起外耳道狭窄的7例单耳患者行外耳道成形术,术后随访时间2～6年,对术后听力恢复情况及成形外耳道效果等进行回顾性分析。结果术中发现合并外耳道胆脂瘤4耳,术后6个月平均纯音听阈及气骨导差分别由术前的64.5 dB nHL和46.4 dB nHL下降至术后6个月的35.1 dB nHL和14.9 dB nHL。术后3个月植皮成形之外耳道完全上皮化、通畅,1例患者术后4年出现外耳道再狭窄,予再次行外耳道成形术,术后随访2年未出现再狭窄。结论单骨型颞骨骨纤维异常增殖症致外耳道狭窄必须尽早治疗,防止并发外耳道胆脂瘤,外耳道成形术效果好,术中可仅行外耳道重建恢复听觉功能,不必强求彻底切除所有病变范围,随访过程中发现外耳道再狭窄可再次手术,预后良好。OBJECTIVE To analyze the therapeutic effect of external auditory canal stenosis caused by monostotic fibrous dysplasia of temporal bone by operation. METHODS Seven patients diagnosed with monostotic fibrous dysplasia of temporal bone uderwent surgery by the reconstruction of external auditory canal. The follow-up lasted 2 to 6 years and pure tone audiometry and recovery of external auditory canal were retrospectively analyzed. RESULTS We found 4 ears with combined external auditory canal cholesteatoma intraoperatively. The mean PTAs and the air-bone gaps （A-B gap）for all the patients improved from 64.5 dBHL and 46.4 dB nHL pre-operatively to 35.1 dB nHL and 14.9 dBHL at 6 months post-operatively. The grafting surface of external auditory canal was completely epithelized by 3 months postoperatively. Restenosis of the external auditory canal appeared in one patient after 4 years. Second canalplasty was performed in this patient and no restenosis was found in subsequent 2 years’ follow-up.CONCLUSION The external auditory meatus stenosis caused by monostotic fibrous dysplasia of temporal bone must be treated as early as possible to prevent complicated cholesteatoma. Satisfactory results can been obtained by canalplasty. We can excise pathological change of external auditory canal simply to restore auditory function. Restenosis of the external auditory canal may be operated again, and the prognosis was optimistic.

关 键 词：纤维发育不良 单骨 颞骨 耳道 外科手术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]