颞骨纤维异常增殖症致外耳道狭窄的手术策略及疗效分析  

Surgical strategy and efficacy analysis of external auditory canal stenosis caused by temporal bone fibrous dysplasia

作　　者：李辰龙 谢友舟 傅窈窈 朱雅颖 张天宇 LI Chenlong;XIE Youzhou;FU Yaoyao;ZHU Yaying;ZHANG Tianyu(ENT Institute,Department of Facial Plastic and Reconstructive Surgery,Eye&ENT Hospital,Fudan University,NHC Key Laboratory of Hearing Medicine(Fudan University),Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻喉科研究院眼耳鼻整形外科,国家卫生健康委员会听觉医学重点实验室(复旦大学),上海200031

出　　处：《中国眼耳鼻喉科杂志》2022年第4期346-349,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：上海市科学技术委员会“科技创新行动计划”自然科学基金项目(20ZR1409900);上海市科学技术委员会“科技创新行动计划”技术标准项目(21DZ2200700)。

摘　　要：目的明确颞骨纤维异常增殖症致外耳道狭窄的手术策略,并对术后效果进行分析。方法收集2002年9月~2020年12月因颞骨纤维异常增殖症致外耳道狭窄在我科接受手术治疗的患者共计18例,手术时平均年龄为(26.8±12.3)岁(9~48岁)。手术方式主要为耳内耳甲切口外耳道成形术,即扩大狭窄外耳道并尽可能保留原外耳道皮肤,同时根据情况行鼓室成形及听力重建。术后随访,对听力、影像学检查以及并发症等进行分析。结果平均随访时间为(5.5±3.1)年(1~11年)。1例患者因外耳道狭窄继发胆脂瘤破坏中耳,术后听力无明显改善;其余17例患者均获得实用听力(气骨导差<30 dB)。1例患者术后发生外耳道骨性增生并行二次手术治疗,其余17例患者外耳道上皮健康,耳道干洁。结论早期开展外耳道成形术是治疗颞骨纤维异常增殖症致外耳道狭窄的理想手术策略,患者术后可以获得健康外耳道和实用听力且长期结果稳定。Objective To clarify the surgical strategy of external auditory canal(EAC)stenosis caused by temporal bone fibrous dysplasia and to analyze the postoperative efficacy.Methods Eighteen patients with external auditory canal stenosis caused by temporal bone fibrous dysplasia treated with surgery from September 2002 to December 2020 in Eye&ENT Hospital of Fudan University were collected.The mean age at surgery was 26.8±12.3 years(ranged from 9 to 48 years).Modified canaloplasty procedure with an endoaural-conchal incision was performed to widen the stenotic EAC.These patients with EAC stenosis still had certain EAC skin which had been carefully preserved.When necessary,tympanoplasty or ossicle mobilization was performed.The patients were followed up and the hearing,CT and complications were analyzed.Results The mean follow-up period was 5.5±3.1 years(ranged from 1 to 11 years).There were 17 patients who obtain serviceable hearing(air-bone gap<30 dB).Another patient did not obtain satisfactory hearing gain due to the middle ear destruction of cholesteatoma.One patient developed bony regrowth of EAC and underwent the canaloplasty again.The remaining 17 patients had healthy EAC epithelium and dry ear canal.Conclusions Earlier canaloplasty is an ideal surgical strategy for EAC stenosis caused by temporal bone fibrous dysplasia.The patients can obtain healthy EAC status and serviceable hearing.And the long-term results are stable.

关 键 词：颞骨 骨纤维异常增殖症 外耳道狭窄 外耳道成形 

分 类 号：R764.91[医药卫生—耳鼻咽喉科]