肌骨膜瓣填塞乳突腔、耳甲腔成形并一期鼓室成形术

Musculo-periosteal flap to obliterate the mastoid cavity,conchaplasty and synchronal tympanoplasty

目的观察对慢性化脓性中耳乳突炎(胆脂瘤或骨疡型)患者行耳后肌骨膜瓣填塞乳突腔、耳甲腔成形、WullsteinIII型鼓室成形术的手术疗效。方法采用耳后切口对37例(37耳)慢性化脓性中耳乳突炎(胆脂瘤或骨疡型)病人施行耳后肌骨膜瓣填塞乳突腔及耳甲腔成形和III型鼓室成形术。结果术后听力平均提高16dB,26耳平均听力达35.8dB,9耳平均听力达25dB。跟踪随访2-4年,术腔均上皮化好,外耳道无痂皮堆积。26例鼓膜形态完全正常,5例鼓膜疤痕内陷,3例鼓膜穿孔但干耳,干耳率91.9%(34/37);3耳仍有间断性流脓,经再次手术干耳,2例胆脂瘤复发,复发率5.4%(2/37)。干耳时间在5-9周,平均6.5周。结论耳后肌骨膜瓣填塞乳突腔、耳甲腔成形并WullsteinIII型鼓室成形术能使术腔迅速上皮化、易干耳,术后听力提高。

Objective To investigate the curative effect of postaural musculo-periosteal flap to obliterate the mastoid cavity,conchaplasty and Wullstein III tympanoplasty on chronic supurative otitis media and mastoiditis with cholesteatoma and/or granulation tissue. Methods 37 cases (37 ears) of chronic supurative otitis media and mastoiditis were treated with postaural musculo-periosteal flap to obliterate the mastoid cavity,conchaplasty and type III tympanoplasty. Results About 16dB average improvement of auditory level was achieved. 26 ears reached auditory level for functional audition(average auditory level 35.8 dB)another 9 for social interaction. (average auditory level 25 dB). After 2-4 years of follow-up, all cases had a good epithelization in the surgical cavity and non-crust in external anditory canal. Tympanic membranes were normal in 26 cases, scars in tympanic membranes sank in 5 cases and the tympanic membranes had perforated in 3 cases with dry ears. Drying ear rate was 91.9%(34/37). 3 ears which intermittently produced pus dried after second surgery operation. Cholesteatoma recurred in 2 cases and the rate of recurrence was 5.4%(2/37). The course of dry ears took about 5 to 9 weeks(average, 6.5 weeks). Conclusion The surgery operations of postaural musculo-periosteal flap to obliterate the mastoid cavity,conchaplasty and Wullstein III tympanoplasty can make the epithelization in the surgical cavity more quickly and short the duration for dry ear. The auditory level was improved after treatment.