先天性耳廓、中耳畸形及外耳道闭锁的整复和鼓室成形术——附52例临床分析

Primary reconstruction and tympanoplasty for patients with congenital malformation in the auricle and middle ear with atresia of external acousticmeatuswith an analysis on 52 cases

目的观察Ⅰ期整复治疗先天性外、中耳畸形和外耳道闭锁并存患者的临床疗效和并发症。方法回顾性分析2000年1月～2007年1月间我科收治52例先天性外耳道闭锁并存中耳畸形患者。其中Ⅰ期全耳廓再造+外耳道成形+听骨链成形19例,耳后置水囊皮肤扩张器+外耳道成形+听骨链成形9例,单纯外耳道成形+听骨链成形20例,单纯外耳道成形+人工听骨安装2例,单纯Ⅰ期全耳廓再造+外耳道成形2例。结果听力重建50例,术后1月听力均有提高,语言频率平均提高25dB以上;其中术后随访6月～5年的38例,29例(76%)语言频率听力平均提高5～40dB。再造耳廓全部成活,其中1例出现耳廓挛缩;外耳道再造52例中,出现外耳道狭窄4例,外听道再闭锁者2例,均经及时处理得到缓解。未出现面瘫及迷路漏管等并发症。结论Ⅰ期整复治疗先天性外、中耳畸形和外耳道闭锁并存患者,并利用自体肋软骨再造耳廓可获得满意效果。

Objective To investigate the ther1apeutic effect of primary reconstruction and tympanoplasty for patients with congenital malformation in the auricle and middle ear with atresia of external acoustic meatus and its complications possibly occurred during and following the surgical performing. Methods A retrospective study was carried out among 52 cases, treated in our Hospital from Jan, 2000 to Jan, 2007, with such a kind of lesion to sum up the clinical experience with their therapeutic course through careful analysis on their clinical data. Among this group of cases, performed were primary whole auricle reconstruction combined with canal reconstruction and tympanoplasty in 19 cases, canal reconstruction and tympanoplasty combined with a cutaneous dilator with water-filled balloon fixed behind the auricle in 9 cases, simple canal reconstruction plus tympanoplasty in 20 cases, simple canal reconstruction combined with auditory ossicle replacement prosthesis in 2 cases, and simple primary whole auricle reconstruction and canal plastic operation in 2 cases. Results 50 cases received tympanoplasty, all were undergone heating their heating elevated an averaged level more than 25 dB in Among the improvement one month after the operation, with the range of speech frequencies, when compared with that before operation. For the 38 cases followed up for a period lasted for 6 months to 5 years out of this group of patients postoperatively, 29 （76%） showed their heating in speech frequencies remained at an elevated level ranged from 5 to 40 dB in various individuals. Furthermore, all the reconstructed auricles were in a status of survival except one showing a shape of contmcture, all the 52 cases with their external auditory canal reconstructed were successful other than 4 with the canal becoming stenosis and 2 with the canal re-closed following the operation, that were put into a remittent situation by remedial treatment, and no other complications occurred, as fcial paralysis and labyrinthine fistulae, among them after the surgical procedttres. Conclusions Better outcome can be obtained from primary reconstruction and tympanoplasty for cases with congenital malformation in the auricle and middle ear with atresia of external acoustic meatus, with the auricles reconstructed by a framework made from the autogenous graft of costal cartilage.