软组织耳道后壁重建并鼓室成形术治疗中耳胆脂瘤的临床疗效观察  

The clinical curative effect of reconstructing posterior wall of auricular meatus in soft tissue and tympanoplasty for cholesteatoma otitis media

作　　者：朱忠寿[1] 魏日富[1] 蔡灿辉[1] 李慧凤[1] 徐杨斌[1] 程道俊[1] 

机构地区：[1]福建医科大学附属宁德市医院耳鼻咽喉科,福建宁德352100

出　　处：《中国现代医学杂志》2014年第22期62-65,共4页China Journal of Modern Medicine

基　　金：宁德市科技局科研立项资助项目(No:宁科20100077)

摘　　要：目的初步探讨采用颞肌骨膜瓣转移外耳道后壁重建技术,修复开放式乳突根治术后外耳道后壁缺损及开放的乳突腔,提高听力、重建外耳道解剖及功能、降低胆脂瘤复发率的临床意义。方法将103例胆脂瘤型中耳炎患者分成三组,A组(研究组)45例行开放式乳突根治术,采用颞肌骨膜瓣转移耳道后壁重建技术同时重建中耳鼓室传音结构;B组(对照组)36例行经典的完壁式乳突切除术;C组(对照组)22例行开放式乳突根治术。A组分别与B、C组在术后听力改善率、干耳率、平均干耳时间、胆脂瘤复发率及外耳道功能良好率几方面进行统计学分析。结果 A组与B组在术后听力改善率、术后干耳率、术后平均干耳时间、外耳道功能良好率差异无显著性,术后胆脂瘤复发率明显降低,差异有显著性。A组与C组比较在术后听力改善率、术后平均干耳时间有显著的提高,外耳道结构及功能得到修复。结论软组织耳道后壁重建并鼓室成形术,在胆脂瘤型中耳炎行乳突切除术中能使病灶彻底得到清除、降低并发症,外耳道原有形态及功能得以修复,又能改善听力,且手术易操作;根据术中情况灵活应用该手术方式可显著降低整组病例术后胆脂瘤复发率;具有临床应用价值。[ Objective ] To explorethe clinical value and significance of using the technique of transferring tem- poralis periosteum connective tissue valve to reconstruct posterior wall of auricular meatus for treatingthe deficient of posterior wall of auricular meatus and open mastoid cavity, after the mastoidectomy, improving hearing function and the self-cleaning function of external meatus. [Methods] 45 patients were operated by radical mastoidectomy after cutting out posterior wall of auricular meatus. The technique of transferring temporalis periosteum connective tissue valvewas used to reconstruct posterior wall of auricular meatus was used and at the same time tympanoplasty was adopted to reconstruct tympanic cavity sound-transmitting function, whose posterior bone-wall of auricular meatus were destroyed or pathological tissues can＇t be outright eliminate by intact-wall-type mastoidectomy. Before and af- ter surgery, the hearing function was measured with pure tone audiometry, and in comparison with 36 patients who suffered from same disorders and proceeded classical intact-wall-type mastoidectomy. [ Results ] The technique of reconstructing posterior wall of auricular meatus in soft tissue could eliminate pathological tissue effectively, diminish complication in and after surgery, reserve and improve the hearing function. The average improvement rate of air conduction hearing was 73.7%; the comparison group was 76.9%. There was no significantlydifference between the two groups. Posterior wall of auricular meatus didn＇t collapse after a long time observation. The self-cleaning func- tion was normal. [ Conclusions ] The technique of reconstructing posterior wall of auricular meatus in soft tissue and tympanoplasty in mastoidectomy about chronic middle ear mastoiditis can completely eliminate pathological tissue, diminish complication, and renovate the initial shape and function of auricular meatus. It can improve the hearing function and the operation is easy to operate. According to the specific situation duri

关 键 词：乳突切除术 耳后壁重建 鼓室成形术 胆脂瘤中耳炎 

分 类 号：R764.92[医药卫生—耳鼻咽喉科] R764.21[医药卫生—临床医学]