115例完壁式乳突切开术中利用耳后肌骨膜瓣下移缝合法防止耳后切口感染效果观察

Effect observation of downward suture of retroauricular myoperiosteal flap to prevent infection of retroauricular incision in 115 cases of complete wall mastoidectomy

[背景]探讨完壁式乳突切开术中利用耳后肌骨膜瓣下移缝合法防止耳后切口感染的可行性.[病例报告]选择行完壁式乳突切开手术耳后肌骨膜瓣下移缝合的115例慢性化脓性中耳炎患者作为观察组,并选择同时期行完壁式乳突切开术耳后肌骨膜瓣原位缝合的156例慢性化脓性中耳炎患者作为对照组,观察两组术后1~3周内的耳后切口感染情况.常规耳后切开行完壁式乳突切开术及中耳手术,术中于术区用电刀制作开口朝前方的ㄩ型肌骨膜瓣.观察组:完成拟定的所有中耳手术后将耳后肌骨膜瓣下移缝合在手术创面下缘与手术切口下方的颞肌上,使乳突腔表面下方1/3部分被耳后肌骨膜瓣覆盖,而上方2/3部分则没有肌骨膜瓣覆盖.对照组:完成拟定的所有中耳手术之后将耳后肌骨膜瓣缝合于原来的位置,使整个乳突腔表面重新被耳后肌骨膜瓣覆盖.结果见,观察组115例患者均未出现术后切口感染,对照组156例中16例(10.3%)在术后出现耳后切口感染,且所有切口感染均位于切口下方.[讨论]完壁式乳突切开术中利用耳后肌骨膜瓣下移缝合法可有效防止耳后切口感染.

BACKGROUND To explore the feasibility of downward suture of retroauricular myoperiosteal flap to prevent posterior auricular incision infection during complete wall mastoidectomy.CASE REPORTS A total of 115 patients with chronic suppurative otitis media who underwent complete wall mastoidectomy and downward suture of retroauricular myoperiosteal flap were selected as the observation group,and 156 patients with chronic suppurative otitis media who underwent complete wall mastoidectomy and in situ suture of retroauricular myoperiosteal flap were selected as the control group.The infection of retroauricular incision of the two groups was observed in 1 to 3 weeks after the operation.Routine retroauricular incision performed wall mastoidectomy and middle ear surgery.During the operation,an electric knife was used to make aㄩtype myoperiosteal flap with the opening facing forward.Observation group:After the completion of all the planned middle ear operations,the retroauricular myoperiosteal flap was downward sutured on the lower edge of the surgical wound and the temporalis below the surgical incision,so that the lower 1/3 of the mastoid cavity surface was covered by the retroauricular myoperiosteal flap,while the upper 2/3 of mastoid cavity surface was not covered by it.Control group:After the completion of all the planned middle ear operations,the retroauricular myoperiosteal flap was sutured to the original position,so that the entire mastoid cavity surface was covered with the retroauricular myoperiosteal flap again.The results showed that none of the 115 patients in the observation group had postoperative incision infection,while 16(10.3%)of the 156 patients in the control group had postoperative retroauricular incision infection,and all the incision infections were located below the incision.DISCUSSION The downward suture method of the retroauricular myoperiosteal flap in the wall mastoidectomy can effectively prevent the infection of the retroauricular incision.