适形骨片后壁重建技术在外耳道胆脂瘤术中应用探讨  

Utility of Conformal Bone Slices in PosteriorWall Reconstruction for External Auditory Canal Cholesteatoma

作　　者：张媛[1] 闫艳[1] 李子博 张晨 张淼[1] 郑凡君 李雨青 王晨晨 刘日渊[1] 赵辉[1] ZHANG Yuan;YAN Yan;LI Zibo;ZHANG Chen;ZHANG Miao;ZHENG Fanjun;LI Yuqing;WANG Chenchen;LIU Riyuan;ZHAO Hui(College of Otolaryngology Head and Neck Surgery,Chinese PLA General Hospital,Chinese PLA Medical School,National Clinical Research Center for Otolaryngologic Diseases,Chinese PLA Institute of Otolaryngology,State Key Labof Hearing Science,Ministry of Education,Beijing Key Lab of Hearing Impairment Prevention and Treatment,Beijing100853,China)

机构地区：[1]中国人民解放军总医院耳鼻咽喉头颈外科医学部,国家耳鼻咽喉疾病临床医学研究中心,解放军耳鼻咽喉研究所,聋病教育部重点实验室,聋病防治北京市重点实验室,北京100853

出　　处：《中华耳科学杂志》2023年第3期356-361,共6页Chinese Journal of Otology

基　　金：科技部国家重点研发计划(2019YFB1311805);国家自然科学基金面上项目(81970895)。

摘　　要：目的 探讨自体乳突皮质骨制备适形骨片重建外耳道后壁治疗Ⅲ期外耳道胆脂瘤的手术效果。方法收集33例乳突气化良好的Ⅲ期外耳道胆脂瘤病例,行部分乳突切开+自体皮质骨外耳道后壁重建术,自体乳突皮质骨雕刻成适形骨片重建外耳道后壁,并以筋膜(骨膜)瓣覆盖完成外耳道成形。结果 33耳手术均顺利完成,共31耳一次手术实现干耳,随访无胆脂瘤复发、无重建外耳道后壁塌陷及狭窄闭锁;其中1例患者术后鼓膜穿孔,二次手术后鼓膜完整、愈合良好;1例患者术后重建的外耳道后壁出现窦道与乳突腔相通而导致间断耳漏,二次手术后干耳并恢复了外耳道的正常生理结构,共32耳干耳。另有1耳外耳道胆脂瘤复发,同时伴耳漏及耳道狭窄。结论部分乳突切开+自体皮质骨适形骨片外耳道后壁重建手术治疗Ⅲ期外耳道胆脂瘤,以筋膜(骨膜)瓣予以覆盖完成外耳道成形,可有效清除病变同时恢复接近正常外耳道的结构,可以进一步应用及深入研究。Objective To report outcomes of reconstruction of the external auditory canal posterior wall with autologous conformal bone slices from mastoid cortical bone for stage III external auditory canal cholestatoma.Methods In 33 patients with stage III cholestatoma of external auditory canal and no mastoid involvement,autologous mastoid cortical bone carved into conformal slices were used in reconstruction of external auditory canal posterior wall,covered with fascia(periosteum)flap.Results Reconstruction was successful in all 33 ears,achieving dry ear in 31 ears with no cholestatoma recurrence,collapse of reconstructed posterior wall or stenosis.One had the Postoperative tympanic membrane perforation was observed in 1 patient,which healed after the secondary repair operation.Intermittent otorrhea occurred in 1 patient with a fistula between the reconstructed posterior wall and the mastoid cavity,which was successfully managed with a follow up surgery that restored the physiological structure of the external auditory canal and dry ear.Recurrence of external ear canal cholesteatoma was seen in 1 case with otorrhea and stenosis.Conclusion Stage III external auditory canal cholestatoma can be treated by partial mastotomy with reconstruction of posterior external auditory canal wall using conformal autogenous cortical bone slices and fascia(periosteum)flap to achieve lesion removal and restoration of normal structure of the external auditory canal.The technique deserves further study and adoption.

关 键 词：期外耳道胆脂瘤 外耳道后壁重建 自体乳突皮质骨 适形骨片制备 带蒂骨膜瓣 

分 类 号：R764[医药卫生—耳鼻咽喉科]