外耳道成形术在筋膜外植法鼓室成形术中的应用

Experience of canalplasty during the overlay tympanoplasty

目的:观察在筋膜外植法鼓室成形术中施行外耳道成形术的作用。方法:在筋膜外植法鼓室成形术同时行外耳道成形术59耳(部分伴完壁式乳突根治术),通过耳道内和耳后联合切口,分离外耳道后壁皮瓣并向前上翻起固定,游离外耳道前壁皮肤,磨除外耳道前下方悬骨及周边骨质,扩大骨性外耳道,开放鼓沟,充分暴露鼓环,鼓膜彻底去上皮化。清除中耳病变后,外植铺放颞筋膜,回复外耳道前壁皮肤和后壁皮瓣,明胶海绵固定。术后1周开始滴耳,外耳道明胶海绵4～6周自然排空。结果:随访0.5～3.5年,所有患者切口Ⅰ期愈合,外耳道宽敞,鼓膜形态好,无皮瓣坏死、外耳道狭窄和胆脂瘤珠形成等并发症。结论:外耳道成形术是筋膜外植法鼓室成形术的必备步骤,有助于鼓膜彻底去上皮化、筋膜铺放及避免胆脂瘤珠形成,并且便于术后观察。

Objective：To report the experience with canalplasty during the operation of overlay tympanoplas ty. Method： A retrospective review was performed on 56 patients （59 ears） that underwent tympanoplasty and canalplasty （part with intact canal wall mastoidectomy）. Transcanal and postauricular incisions were made, and the posterior canal skin flap was elevated and fixed with retractor, while the anterior flap was freed. A drill was used to remove the anterior and inferior bone bulges and the adjacent bone to expose the tympanic sulcus and annu lus adequately, and the epithelium of tympanic membrane remnant was removed thoroughly. After the eradication of the middle ear disease, temporal fasia was used as an overlay graft and the canal skin was replaced, and the gel foam soaked in antibiotic and Dexamethasone solution was used to compress the canal. The patients began to use ear drops 1 week after surgery, and the gelfoam in canal lasted for 4 6 weeks. Result：Follow up was conducted for 0.5--3.5 years respectively, all patients gained stage I incision cure, the external auditory canal was wide and tympanic membrane gained a good shape, the complications of skin flap necrosis, external canal stenosis and cholesteatoma pearl were not occurred. Conclusion：Canalplasty was the necessary procedure in the operation of o verlay tympanoplasty which could conduce to de-epithelization of the membrane, placement of fasia and prevention of the occurrence of cholesteatoma pearl.