全层整片软骨结合外嵌技术在开放式乳突根治+鼓室成形术中的应用  

The Application of the Whole Full-thickness Cartilage Combining Over-inlay Technique in Open Mastoidectomy and Tympanoplasty

作　　者：叶成刚 汪雷[1] 廖华[1] Ye Chenggang;Wang Lei;Liao Hua(Department of Otolaryngology,Head and Neck Surgery of Renmin Hospital of Wuhan University)

机构地区：[1]武汉大学人民医院耳鼻咽喉头颈外科中心1科(耳科),武汉430060

出　　处：《听力学及言语疾病杂志》2022年第5期507-510,共4页Journal of Audiology and Speech Pathology

摘　　要：目的探讨开放式乳突根治+鼓室成形术中采用全层整片软骨外嵌技术的临床应用效果。方法回顾性分析2017年1月~2019年12月在武汉大学人民医院耳鼻咽喉头颈外科因中耳胆脂瘤接受开放式乳突根治+鼓室成形术共计155例单侧患者的临床资料,其中男84例,女71例,平均年龄38.3±4.3岁,病程1~32年,平均7.3±2.3年,全部以全层整片软骨为鼓膜移植物,外嵌法鼓室成形,术中采用部分听骨赝复物(partial ossicular replacement prosthesis,PORP)重建听力113例,采用全听骨赝复物(total ossicular replacement prosthesis,TORP)重建听力42例,术后随访12~36个月。记录患者术前术后纯音听阈、耳内镜图像及术后并发症。结果除2例患者术后两周因感染导致软骨部分坏死外,其余153例患者均于术后6周左右干耳,平均干耳时间45.5±5.0天。PORP组术前平均气导听阈46.3±10.4 dB HL,平均气骨导差30.1±5.3 dB,术后一年平均气导听阈及气骨导差分别为30.6±8.3 dB HL、15.4±5.2 dB,均较术前显著降低(P<0.01);TORP组术前平均气导听阈53.5±8.5 dB HL,平均气骨导差35.9±4.6 dB,术后一年平均气导听阈及气骨导差分别为36.5±7.4 dB HL、18.9±8.6 dB,均较术前显著降低(P<0.01);153例鼓膜移植物均存活良好,无内陷及外侧愈合;术后无感音神经性聋、面瘫、眩晕等并发症发生。结论全层整片软骨结合外嵌技术在开放式乳突根治+鼓室成形术中具有良好的应用价值。Objective To investigate the clinical value of the whole full-thickness cartilage combining the over-inlay technique in open mastoidectomy and tympanoplasty.Methods A total of 155 patients(84 males and 71 females,with an average age of 38.3±4.3 years old,The course of disease ranged from 1 to 32 years,with an average of 7.3±2.3 years),who underwent open mastoidectomy and tympanoplasty using the whole full-thickness cartilage technique in the Department of Otorhinolaryngology head and Neck Surgery,People’s Hospital of Wuhan University from January 2017 to December 2019 were retrospectively analyzed.the whole full-thickness cartilage combining the over-inlay technique was used in all the patients.Postoperative follow-up was 12 to 36 months.Partial ossicular prosthesis(Total Ossicular Replacement Prosthesis,PORP)was used for reconstruction of hearing in 113 cases and total ossicular prosthesis(Total Ossicular Replacement Prosthesis,TORP)in 42 cases.Pure tone auditory threshold,otoscope images and complications were analyzed before and after surgery.Results Two patients had partial cartilage necrosis due to infection two weeks after surgery,and the other patients had dry ear about 6 weeks after surgery,with an average dry ear duration of 45.5±5.0 days.In PORP group,the average air conduction threshold was 46.3±10.4 dB HL,and the average air-bone gap was 30.1±5.3 dB.The average air conduction threshold and the air-bone gap were 30.6±8.3 dB HL,15.4±5.2 dB respectively one year after surgery,which were significantly reduced compared with that before surgery(P<0.01);The TORP group,the average air conduction threshold was 53.5±8.5 dB HL,and the average air-bone gap was 35.9±4.6 dB.The average of air conduction and the air-bone gap conduction were 36.5±7.4 dB HL and 18.9±8.6 dB respectively one year after surgery,which were significantly reduced compared with that before surgery(P<0.01).All the 153 tympanic membrane grafts survived well without invagination or lateral healing except 2 patients.There were no po

关 键 词：全片整层软骨 外嵌法 开放式乳突根治术 鼓室成形术 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]