乳突切除并外耳道后上壁软壁重建一期鼓室成形术

Radical Mastoidectomy with Soft Wall Reconstruction of the External Canal in Tympanoplasty

目的探讨慢性化脓性中耳炎一期听力重建鼓室成形术中外耳道后上壁软壁重建的临床应用。方法 2000年11月～2004年10月间对68例(72耳)慢性化脓性中耳炎患者进行乳突根治加一期听力重建鼓室成形术,其中34耳利用耳后肌骨膜瓣重建外耳道后上壁,完成"完壁"的鼓室成形术。将随访资料完整且手术成功的32耳和33耳开放式鼓室成形术的听力情况及外观形态进行回顾性对比分析。结果术后12个月纯音听力检查,外耳道后壁软壁重建组术前术后骨气导差缩短值<15dB、>15dB,分别为18、14耳,而开放式鼓.室成形术组分别为21、12耳,两组比较差异无显著性。术后12个月以上定期检查结果显示,"后壁重建"组重建的外耳道后壁形态满意,无明显内陷或膨隆,无上皮样耵聍堆积。而"开放成形术"组13耳形成外耳道"窟窿"畸形,10耳乳突术腔上皮样耵聍堆积和需反复定期清理。结论慢性化脓性中耳炎多数可行一期听力重建鼓室成形术。外耳道后上壁软壁重建一期鼓室成形术,外观形态满意,听力重建可靠;且结构功能重建符合生理,有一定的临床应用价值。

Purpose To study the clinical apllication of soft wall reconstruction of the extemal canal in primary tympanoplasty for the patients with chronic suppurative otitis media. Methods From November 2000 to August 2004,68 patients （72 ears） with chronic suppurative otitis media were operated on for primary tympanoplasty, in which 34 ears were operated on for soft wall reconstruction of the external canal with post auricular muscle flap, that is, intact external canal tympanoplasty. A retrospective analysis and compfison were made between the intact external canal reconstruction group（ 32 ears） and the open tymanoplasty group （33 ears）. Results One year after operation, the shifts of difference in thresholds of bone and air conduction were less than 15 dB（ 18 ears）, more than 15 dB（ 14 ears） in the ＂intact＂group; less than 15 dB（21 ears）, more than 15 dB（ 12 ears） in the ＂open＂ group. No significant difference was found between the two groups. Regular examination showed that the external canal displayed normal appearance without collapse or protrusion, and no epithelium-like ceruman was found in the ＂intact＂ group. However, in the ＂open＂ group malformation of the external canal was found in 13 ears and cumulation of cerumen in 10 ears. Condusion Tympanoplasty with reconstruction of soft wall of external canal can not only obtain a satisfactory contour but also promote recovery of hearing. The value of the reconstruction of soft wall of external canal is viable and feasible.