鼓窦桥技术在耳内镜下外耳道重建中的初步应用  

Preliminary application of tympanic antrum bridge technique in reconstruction of external auditory canal under otoendoscope

作　　者：刘雪峰 杨蒙生[1] 郜飞 何佳怡 杨智玲[1] 卫旭东[1] 何健[1] LIU Xuefeng;YANG Mengsheng;GAO Fei;HE Jiayi;YANG Zhiling;WEI Xudong;HE Jian(Department of Otolaryngology Head and Neck Surgery,Gansu Provincial People's Hospital,Lanzhou,Gansu,730000,China)

机构地区：[1]甘肃省人民医院耳鼻咽喉头颈外科,甘肃兰州730000

出　　处：《中国耳鼻咽喉头颈外科》2023年第2期74-78,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探索耳内镜手术中鼓窦桥技术在外耳道重建中的临床应用价值。方法选取2019年1月~2021年6月间收治并行耳内镜手术的单侧中耳胆脂瘤病例12例,7例患者术前颞骨CT提示上鼓室及鼓窦低密度影,鼓窦口骨质破坏变宽;5例患者术前的颞骨CT显示上鼓室、鼓窦及乳突低密度影像,伴骨质破坏。术中耳内镜下及术后病理回报提示均证实胆脂瘤形成。手术均在耳内镜下完成,术中保留鼓窦桥形结构,彻底清除病变,重建听骨链,术后应用鼓窦桥技术重建外耳道。术后随诊1年,观察疗效。结果12例术前听阈为(47.50±7.53)dB HL,气骨导差为(27.08±5.82)dB HL,术后随访期内听阈为(30.00±6.03)dB HL,气骨导差为(15.00±2.13)dB HL;术前外耳道容积为(2.41±0.45)ml,术后外耳道容积为(1.65±0.19)ml;重建材料均来自耳屏软骨和耳甲腔软骨。所有病例随访期内均无外耳道狭窄、塌陷,外耳道形态稳定。3个月内均获得干耳。结论耳内镜下鼓窦桥技术可减轻外耳道重建的难度,有利于外耳道形态的重塑和微创的实现。OBJECTIVE To explore the clinical value of tympanic-antrum bridge technique in the reconstruction of external auditory canal in endoscopic surgery.METHODS From January 2019 to June 2021,12 patients with unilateral middle ear cholesteatoma who underwent endoscopic surgery were selected.Preoperative temporal bone CT of 7 patients showed low density shadow in the superior tympanic cavity and tympanic antrum,and the bone of aditus ad antrum was destroyed.Five patients showed low density images of superior tympanic cavity,tympanic antrum and mastoid process with bone destruction.The formation of cholesteatoma was confirmed by intraoperative ear endoscope and postoperative pathological findings.All the operations were completed under ear endoscope.During the operation,the tympanus-antrum bridge structure was preserved,the lesions were completely removed,and the ossicular chain was reconstructed.After the operation,the external auditory canal was reconstructed by tympanus-antrum bridge technique.Follow-up was performed for 1 year to observe the curative effect.RESULTS The hearing threshold and air-bone conduction gap were(47.50±7.53)dB HL and(27.08±5.82)dB HL before operation,(30.00±6.03)dB HL and(15.00±2.13)dB HL after operation.The preoperative and postoperative volume of external auditory canal was(2.41±0.45)ml and(1.65±0.19)ml respectively.The reconstruction materials were all from tragus cartilage and concha cavity cartilage.During the follow-up period,there was no external auditory canal stenosis or collapse,and the shape of external auditory canal was stable.Dry ears were obtained in all patients within 3 months.CONCLUSION Endoscopic tympano-antrum bridge technique can reduce the difficulty of external auditory canal reconstruction,which is beneficial to the preservation of external auditory canal shape and minimal invasion realization.

关 键 词：内窥镜检查 胆脂瘤 中耳 耳内镜手术 鼓窦桥技术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]