耳甲腔成形及耳后带蒂肌骨膜瓣乳突填塞对开放式乳突根治术疗效分析

The analysis of effects of plastic surgery of external auditory canal and cavity obliteration with palva flap after Modified radical mastoidectomy with canal wall down

目的探讨耳甲腔成形及耳后带蒂肌骨膜瓣乳突填塞对开放式乳突根治术疗效的影响。方法 2004年2月～2008年8月间在我院接受手术治疗的122例(122耳)患者中,57耳采用乳突根治术(改良乳突根治术)+改良耳甲腔成形术及耳后带蒂肌骨膜瓣填塞根治腔(实验组),65耳行常规手术方法,即采用乳突根治+经典耳甲腔成形术,未做耳后肌骨膜瓣填塞(对照组)。术后随访时间为0.5～1年,观察两组患者术后干耳率和复发率情况。结果实验组干耳率为96.5%,明显高于对照组(80.0%)(P<0.05)。实验组术后复发率(1.85%)低于对照组(7.7%),但差异无统计学意义(P>0.05)。结论两种术式的患者其术后复发率的差异不明显,改良耳甲腔成形术+耳后带蒂肌骨膜瓣填塞开放式乳突根治腔,不但扩大了外耳道口,且缩小术后根治腔,促进乳突腔的上皮化及通气引流,提高术后干耳率,从而提高开放式乳突根治术的疗效。

Objective To explore the effects of Plastic surgery of external auditory canal and cavity obliteration with palva flap after Modified radical mastoidectomy with canal wall down.Methods 122 cases（122 ears） of Cholesteatoma from february 2004 to august 2008 who underwent Modified radical mastoidectomy were analyzed,the cases have been divided into two groups in which,one was study group which involved 57 cases who were underwent the Plastic surgery of external auditory canal and cavity obliteration with palva flap after Modified radical mastoidectomy with canal wall down,another one was control group which involved 65 cases who underwent Modified radical mastoidectomy with canal wall down only without cavity obliteration.Then recurrence and dry ear rates have been estimated for 6～12 months after operations.Results The dry ear rate of study group was significantly higher than the control group（P0.05）（96.5% vs 80.0%）,while the recurrence rate of study group was lower than that of the control group（1.85% vs 7.7%）,but there was no statistical difference between two groups（P0.05）.Conclusion There was no statistical difference of the recurrence rates of two groups.The Plastic surgery of external auditory canal and cavity obliteration with palva flap after Modified radical mastoidectomy with canal wall down can enlarge the external acustic orifice and contract the operation cavity,which can accelerate the epitheliezation of mastoid cavity and air ventilation as well as raising the dry ear rate.