灌流模式软骨膜-软骨-软骨膜复合体重建上鼓室外侧壁的临床应用  

Clinical application of perichondrium-cartilage-perichondrium complex in reconstruction of lateral wall of upper tympanum in perfusion mode

作　　者：张亚戈 李谊[1] ZHANG Yage;LI Yi(Department of Otolaryngology Head and Neck Surgery,the 988th Hospital of the People’s Liberation Army Joint Security Force,Zhengzhou 450042,China)

机构地区：[1]中国人民解放军联勤保障部队第988医院耳鼻咽喉头颈外科,河南郑州450042

出　　处：《中国耳鼻咽喉颅底外科杂志》2023年第5期31-35,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：河南省医学科技攻关省部共建重点项目(SBGJ202102207)。

摘　　要：目的探讨耳内镜灌流模式下应用软骨膜-软骨-软骨膜复合体重建上鼓室外侧壁在上鼓室胆脂瘤(包含外耳道胆脂瘤和中耳胆脂瘤)手术中的临床治疗效果。方法回顾性分析纳入研究的29例患者(外耳道胆脂瘤14例,中耳胆脂瘤15例),其上鼓室全部被胆脂瘤侵犯破坏,彻底清除上鼓室及听骨链病变后,应用耳内镜在灌流模式下选取耳屏或耳甲腔软骨膜-软骨-软骨膜复合体重建上鼓室外侧壁。结果术前气导听力(42.51±3.55)dBHL,术后3个月为(26.22±5.12)dBHL;术前气骨导差(28.67±6.31)dBHL,术后3个月为(13.11±6.56)dBHL,经比较差异均具有统计学意义(P均<0.05)。术后定期随访,出现耳鸣5例,眩晕3例,内陷袋1例,人工听骨赝复物脱出1例,外耳道狭窄3例,鼓膜穿孔1例;耳鸣、耳闷、眩晕经对症处理后症状消失,内陷袋及人工听骨赝复物脱出的患者听力改善尚可,继续观察随访;鼓膜穿孔及外耳道狭窄再次行手术处理后痊愈。结论耳内镜灌流模式下软骨膜-软骨-软骨膜复合体在清除胆脂瘤后,重建上鼓室外侧壁,可有效恢复中耳鼓室解剖结构,显著提高患者术后听力,促进患者术后恢复,降低术后并发症发生率,治疗效果确切。Objective To investigate the clinical effect of the reconstruction of the lateral wall of upper tympanum with perichondrium-cartilage-perichondrium complex in the operation of cholesteatoma of upper tympanum(including cholesteatoma of external auditory canal and cholesteatoma of middle ear)under otoscopic perfusion mode.Methods In the study,a retrospective analysis was performed on 29 patients(14 cases of cholesteroma in the external auditory canal and 15 cases of cholesteroma in the middle ear),all of whose upper tympanum was all invaded and destroyed by cholesteatoma.After the lesions of upper tympanum and ossicular chain were completely removed,the perichondrium-cartilage-perichondrium complex of tragus or concha cavity was selected to reconstruct the lateral wall of the upper tympanum by otoendoscope under perfusion mode.Results The air conduction hearing were(42.51±3.55)dBHL before operation and(26.22±5.12)dBHL three months after operation.The air-bone conduction difference was(28.67±6.31)dBHL before surgery and(13.11±6.56)dBHL three months after surgery.And there were statistically significant differences between them(P all<0.05).After regular follow-up,tinnitus occurred in 5 cases,vertigo in 3 cases,invagination bag in 1 case and prolapse of artificial ossicular prosthesis in 1 case,external auditory canal stenosis in 3 cases and tympanic membrane perforation in 1 case.After symptomatic treatment,the symptoms of tinnitus,ear tightness and vertigo disappeared,and the hearing of patients with invaginated bags and prolapse of artificial ossicular prosthesis was still improved.After further observation and follow-up,the perforation of tympanic membrane and stenosis of external auditory canal were cured after surgical treatment again.Conclusion The perichondrium-cartilage-perichondrium complex under otoendoscopic perfusion mode can reconstruct the lateral wall of upper tympanum and restore the anatomical structure of middle ear tympanum after cholesteatoma removal,which can significantly improve the postope

关 键 词：耳内镜 软骨膜-软骨-软骨膜复合体 灌流模式 上鼓室外侧壁 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]