耳廓全层整片软骨结合外嵌技术在Ⅱ、Ⅲ型鼓室成形术中的应用  

The Application of the Whole Full-thickness Cartilage Combining Over-inlay Technique in TypeⅡ,ⅢTympanoplasty

作　　者：汪雷[1] 廖华[1] 杨希林[1] 徐勇[1] 王文静[1] 任杰[1] 张志坚[1] 舒婧 Wang Lei;Liao Hua;Yang Xilin;Xu Yong;Wang Wenjing;Ren Jie;Zhang Zhijian;Shu Jing(Department of Otolaryngology Head and Neck Surgery,Renmin Hospital of Wuhan University,Wuhan,430060,China;不详)

机构地区：[1]武汉大学人民医院耳鼻咽喉头颈外科中心,武汉430060 [2]武汉大学人民医院麻醉科

出　　处：《听力学及言语疾病杂志》2022年第6期632-636,共5页Journal of Audiology and Speech Pathology

摘　　要：目的探讨耳廓全层整片软骨结合外嵌技术在II、Ⅲ型鼓室成形术中的应用效果。方法回顾性分析2016年1月~2018年12月在武汉大学人民医院耳鼻咽喉头颈外科以耳廓全层整片软骨为移植材料采用外嵌法(将整片软骨置于纤维鼓环外侧,并将部分软骨片嵌顿于鼓切迹)行Ⅱ、Ⅲ型鼓室成形术的160例(165耳)患者的临床资料,年龄18~65岁,平均33.5±9.2岁;其中鼓室硬化98耳,上鼓室胆脂瘤47耳,粘连性中耳炎20耳。术中采用部分听骨赝复物(PORP)重建听力105耳,采用全听骨赝复物(TORP)重建听力60耳,术后随访12~36个月。分析患者术前、术后纯音听阈,耳内镜图像及并发症,观察部分患者术后颞骨CT显示的鼓室含气腔情况。结果PORP组术前0.5~4 kHz平均气导听阈51.34±10.46 dB HL,平均气骨导差32.88±5.25 dB,术后一年平均气导听阈及气骨导差分别为30.24±8.66 dB HL、13.60±6.18 dB,术后均较术前显著降低(P<0.01);TORP组术前平均气导听阈54.85±9.48 dB HL,平均气骨导差34.59±6.85 dB,术后一年平均气导听阈及气骨导差分别为34.24±9.75 dB HL、15.77±7.26 dB,术后均较术前显著降低(P<0.01)。术后鼓膜移植物存活率98.8%(163/165);70%患者(14/20)术后颞骨CT提示鼓室腔含气良好,术后无感音神经性聋、面瘫、眩晕发生。结论耳廓全层整片软骨是一种良好的鼓膜移植物,结合外嵌技术应用于Ⅱ、Ⅲ型鼓室成形术效果佳,具有良好的应用价值。Objective To study the outcome of using the whole full-thickness cartilage combining the over-inlay technique in typeⅡandⅢtympanoplasty.Methods A retrospective study was performed on 160 patients(165 ears),aged 18~65 years,who underwent typeⅡandⅢtympanoplasty using the whole full-thickness cartilage as graft material in department of Otolaryngology Head and Neck Surgery,Renmin Hospital of Wuhan University from January 2016 to December 2018.The mean age was 33.5±9.2 years,including 98 ears of tympanosclerosis,47 ears of superior tympanic cholesteatoma,and 20 ears of adherent otitis media.A total of 105 ears were reconstructed with partial ossicular prosthesis(PORP),and a total of 60 ears were reconstructed with total ossicular prosthesis(TORP).Postoperative follow-up was 12~36 months.Pure tone auditory threshold and otoscope images and complications were analyzed before and after surgery,and the tympanic cavity was observed on CT scan of temporal bone in some patients.Results In PORP group,the average air conduction threshold before surgery was 51.34±10.46 dB HL,and the average air-bone gap was 32.88±5.25 dB.The average air conduction threshold and the air-bone gap were 30.24±8.66 dB HL,13.60±6.18 dB respectively one year after surgery,which were significantly reduced compared with those before surgery(P<0.01).In TORP group,the average air conduction threshold was 54.85±9.48 dB HL,and the average air-bone gap was 34.59±6.85 dB before surgery.The average of air conduction and the air-bone gap conduction were 34.24±9.75 dB HL and 15.77±7.26 dB respectively one year after surgery,which were significantly reduced compared with those before surgery(P<0.01).The survival rate of tympanic membrane graft was 98.8%(163/165).After operation,70%of the patients(14/20)were found to have good pneumatic space in the tympanic cavity by CT scan of temporal bone,and there were no cases of sensorineural deafness,facial paralysis and vertigo.Conclusion The whole full-thickness cartilage is a good tympanic membrane gra

关 键 词：耳廓全层整片软骨 外嵌技术 鼓室成形术 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]