断桥式乳突根治术中用带蒂颞肌骨片重建外耳道后壁

Primary posterior canal reconstruction with a pedicle temporalis musculo-osseous flap in open tympanoplasty

目的探讨在开放式鼓室成形术中,既能彻底清除病灶,又能恢复正常的中耳及外耳道解剖结构的方法,达到提高听力的目的。方法用带蒂颞肌骨片对47例(耳)胆脂瘤型中耳炎病人于开放式鼓室成形术中,行外耳道壁修复重建术。结果 47例(耳)病人术后经0．5-3年随访,12耳听力提高15 dB(25．53％),15耳提高20 dB (31．91％),7耳提高30 dB(14．89％),3耳提高40 dB(6．38％),2耳提高50 dB(4．26％);8耳提高小于15 dB(17．02％)。所有重建的外耳道壁及中耳乳突腔均接近正常状态,无外耳道闭锁或塌陷。结论利用带蒂颞肌骨片在开放式鼓室成形术中行外耳道壁重建,既能彻底清除中耳乳突腔内的胆脂瘤及肉芽组织,又能保证良好的外耳道和中耳的形态和功能,术后听力提高明显,是较为理想的手术方式。

Objective To explore means of maintaining normal status of the middle ear and external meatus while completely removing pathological tissues during open tympanoplasty in order to improve postoperative hearing results. Methods 47 patients underwent canal wall reconstruction using a pedicle temporalis musculoosseous flap after open tympnoplasty. Results The patients were followed up for 6 to 36 months after operation. The hearing improvement was 15 dB in 12 ears （25.53%）, 20 dB in 15（31.91%）, 30 dB in 7 （14.89%）, 40 dB in 3 （6.38%）, 50 dB in 2（4.26%） and less than 15 dB in 8 ears （17.02%）, respectively. All 47 patients showed a nearly normal external meatus and middle ear status postoperatively. No aural atresia and collapse of the canal wall happened. Conclusion Using a pedical temporalis musculoosseous flap to reconstruct canal wall after open tympanoplasty could preserve nearly normal morphology and function of the middle ear and external meatus while completely removing the cholesteatoma and granulation tissue, and resulted in significant hearing improvement after operation.