耳手术后发生外耳道狭窄、闭锁的分析  

Iatrogenic stenosis or atresia of external auditory canal

作　　者：厉瑞飞 胡静[2] 柴亮[2] 

机构地区：[1]浙江省兰溪市人民医院耳鼻咽喉科,兰溪321100 [2]浙江大学医学院附属第一医院耳鼻咽喉科,杭州310003

出　　处：《中华耳科学杂志》2012年第3期330-333,共4页Chinese Journal of Otology

摘　　要：目的通过对9例手术后发生耳道狭窄、闭锁患者临床资料的分析研究,探讨医源性外耳道狭窄、闭锁的发病原因,病变特点及治疗方法。方法回顾性研究我院2007.1～2009.1,131例(133耳)外耳道、中耳手术的病例资料,其中9例(10耳)出现术后狭窄或闭锁(7.52%)。结果 4例外耳道胆脂瘤(5耳),2例外耳道良性肿瘤,2例恶性肿瘤,1例胆脂瘤型中耳炎术后出现外耳道狭窄或闭锁,发生时间均在术后三个月以内,且在手术当中均有外耳道骨质暴露而未进行皮肤移植。狭窄病例局部药物处理后病情改善,闭锁病例半年后再次行外耳道成形术效果良好。结论对原发外耳道、中耳疾病(肿瘤、外耳道胆脂瘤等)术中处理不当,术后复诊、换药不及时均会造成医源性外耳道狭窄、闭锁。objective To analytically investigate the clinical data of patients with external auditory canal atresia or stenosis after surgical therapy, and to discuss its causes, characteristics and appropriate therapeutic methods. Methods Retrospective study in a tertiary referral hospital. 133 ears of 131 patients with external auditory canal diseasea or middle ear diseases underwent surgical intervention between January 2007 and January 2009. The surgical technique is described in detail. 10 ears of 9 patients occurred atresia or stenosis after operations. Results For 9 patients （10 ears ） with atresia or stenosis, there were 4 patients （5 ears） with external auditory canal cholesteatoma, 2 with benign tumor, 2 with malignant tumor in external auditory canal and 1 with chronic otitis media with cholesteatoma. Bone exposure of external auditory canal and without skin transplantation during the operation were the risk factors for stenosis or atresia. All the atresia or stenosis symptoms occurred within the first 3 postoperative months. Stenosis progress could be significantly alleviated by treatment with ototopical antibiotics and steroids.Canalplasty was still a safe and effective technique in the re-atresia cases. Conclusion The most common cause of iatrogenic external auditory canal atresia or stenosis in original external or middle ear diseases is intraoperative improper manipulations. Delayed postoperative management and appointment is another cause of these diseases.

关 键 词：外耳道狭窄 外耳道闭锁 外科手术 

分 类 号：R764.71[医药卫生—耳鼻咽喉科]