带蒂颞肌筋膜显微修复中耳胆脂瘤鼓膜与重建外耳道后壁  

A novel technique for micro-reconstruction of posterior wall of external auditory canal and tympanum in patients with chronic supprative otitis media using pedicled temporalis myofascia

作　　者：于锋 艾毛毛 

机构地区：[1]广州市耳鼻咽喉头颈外科医院,广州510620

出　　处：《中华显微外科杂志》2013年第6期553-557,共5页Chinese Journal of Microsurgery

基　　金：广东省科技计划项目（20108031600015）

摘　　要：目的研究采用带蒂颞肌筋膜在中耳胆脂瘤手术重建外耳道后壁及鼓室成型术中手术方法并评价治疗效果。方法选择97例胆脂瘤型中耳炎患者进行手术治疗，方法为完整保留外耳道皮肤，开放式乳突根治术彻底清理病变，采用带蒂颞肌筋膜的筋膜内、外置法修复鼓膜，联合带蒂颞肌筋膜的蒂部、带蒂耳后骨膜瓣及完整保留外耳道皮肤重建外耳道后壁。术前、术后均作纯音测听，记录0．5、1．0、2．0、4．0kHz气导及骨导听阈值，取该4个频率的平均值作为患者的气导、骨导听阈值；术后3周取出外耳道纱条后第1次复查听力，至少随访2年以上。比较手术前、后语言频率平均听阈（Pure tone audiometry，PTA）的气导、骨导及术后气骨导差进行分析。结果97耳中手术后鼓膜愈合率为95．88％（93／97），96耳访2年，1例失访，随访中有4耳鼓膜穿孔，鼓膜穿孔愈合率为93．85％（92／97）。96耳2年随访，术前平均气导为（52．10±3．96），术后气导（35．67±2．52），术前平均气骨导差为（36．61±5．22）dB，术后气骨导差为（12．14±6．20）dB。术前和术后气导、术前和术后气骨导差差异有统计学意义（P〈0．05）。结论该术式突破原有的开放式乳突根治术常规切开外耳道后壁的手术模式，恢复其正常外耳道生理功能；病变清除彻底，传音系统、鼓室乳突气化态得以重建、复原或维护，提高了听力及鼓膜愈合率。Objective To explore a novel surgical treatment for chronic suppurative otitis media （CSOM） and evaluate its treatment effect. Methods All 97 patients with chronic suppurative otitis media were chosen to be treated using this new surgical method. The skin of the external auditory canal was maintained intact. Open radical mastoidectomy was used to complete clean-up lesions ; the fascia of pedicled temporalis myofascia （PTM） was used to repair the tympanic membrane. The pedicled temporalis fascia, pedicled postauricular periosteal flap and intact skin of the external auditory canal were used in reconstruction of the posterior wall of external auditory canal. Pure tone audiometry （PTA） was performed before and after surgery, recording the air conduction and bone conduction thresholds at 0. 5 kHz, 1.0 kHz, 2. 0 kHz, 4. 0 kHz. The average of the patient＇s air and bone conduction hearing thresholds was recorded at the 4 frequencies. External auditory canal gauze was removed 3 weeks after surgery. All subjects were followed up for over 2 years. Comparison of hearing thresholds （PTA） was made .（1）Before and 4 weeks after surgery. （2） Before and 2 years after surgery. Hearing function comparison include air conduction （ AC ） , bone conduction （BC） and air-bone gap （ABG） analysis. SPSS 16. 0 was used in statistical analysis. Pre-and post- operated AC, BC and ABG were compared using T-test. P 〈 0.05 was considered statistically significant. Results The healing rate of post-operated tympanic membrane was 95.88% （93/97）. Ninty-six ears had 2-year follow-up, and 1 patient was lost in follow-up. There were 2 patients presented with eardrum perforation during the follow-up, and the 2-year healing rate of tympanic membrane perforation was also 93.85 % （92/97 ）. In 96 ears with 2-year followed-up, the average of pre-AC was （52. 10 ± 3.96） dB, the average of post-AC was （35.67 ± 2. 52） dB ; the average of pre- ABG was （36. 6 ± 5.2） dB, and the average of post-ABG （ �

关 键 词：中耳炎 鼓室成形术 外耳道 组织瓣 

分 类 号：R764[医药卫生—耳鼻咽喉科]