耳屏软骨加颞肌筋膜重建上鼓室外侧壁的临床应用  

The lateral attic wall reconstruction with tragal cartilage and temporalis fascia graft

作　　者：邵永良[1] 周永青[1] 李晓明[1] 陈旭真[1] 王玲[1] 高春梅[1] 

机构地区：[1]白求恩国际和平医院耳鼻咽喉头颈外科,石家庄050082

出　　处：《临床耳鼻咽喉头颈外科杂志》2015年第22期1981-1984,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨耳屏软骨加颞肌筋膜重建上鼓室外侧壁的临床应用及术后效果。方法:回顾性分析2005-01-2014-07期间住院手术的45例患者,中耳病变局限于上鼓室,31例胆脂瘤型中耳炎,14例外耳道胆脂瘤,经耳后切口行上鼓室开放术,切除盾板及上鼓室外侧骨壁,充分暴露上鼓室,清除上鼓室病变组织,用耳屏软骨重建上鼓室外侧骨壁,颞肌筋膜覆盖软骨并修复缺损鼓膜及外耳道皮肤,并于术后10d、1个月、2个月、6个月、1年进行随访。结果:术后2个月时,45例患者术区1期愈合;术后6个月,所有患者术区上皮化完好;术后1年,37例患者修复区形态正常听力稳定,7例患者修复区出现不同程度鼓膜内陷,1例出现内陷伴胆脂瘤上皮生长。结论:对于单纯侵及上鼓室的病变组织,可经耳后切口行上鼓室开放术以切除病变,用耳屏软骨加颞肌筋膜重建上鼓室外侧壁,依靠软骨的支撑,可维持鼓室含气腔,减少原鼓膜松弛部内陷的发生,保持上鼓室外侧壁的基本形态。Objective：To investigate the reconstruction method of lateral attic wall with tragal cartilage and temporalis fascia graft.And analyze the postoperative result of its clinical application.Method：From Jan 2005 to Jul 2014,45 patients whose middle ear disease were limited to attic received this surgery in our department.Among 31 cases of cholesteatoma otitis media and 14 cases of external auditory canal cholesteatoma were included.In order to expose the attic fully,we operated epitympanotomy through retroauricular incision and then removed the scutum and lateral attic bone wall.After eliminating the lesions,we reconstructed the lateral attic bone wall with tragal cartilage,covered the cartilage with temporalis fascia and then repaired the tympanic membrane and external ear canal skin.After surgery,all patients were followed up at 10 days,1month,2months,6months and1 year.Result：Two months after surgery,45patients′achieved one-stage wound healing.Six months later,all of the patients′operation area had epithelized completely.After 1year,37 patients had recovered the normal shapes and stable audition;7cases patients have different level tympanic membrane retraction;1patient suffered from tympanic membrane retraction and recurrent cholesteatoma.Conclusion：With regard to the lesion limited to the attic,we can remove it by operating epitympanotomy through retroauricular incision,and then reconstruct the lateral attic wall with tragal cartilage and temporalis fascia.By the support of the cartilage,we can keep the epitympanic aeration,reduce the retraction of pars flaccida membrana tympani,and maintain the fundamental shape of lateral attic wall.

关 键 词：耳屏软骨 颞肌筋膜 上鼓室 胆脂瘤 外科手术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]