自体组织充填乳突腔、耳甲腔成形并一期鼓室成形术

Autologous Tissue to Obliterate Mastoid Cavity,Conchaplasty and Synchronal Tympanoplasty

目的观察慢性化脓性中耳炎术中采用自体组织充填乳突腔、耳甲腔成形术、WullsteinⅢ鼓室成形术的手术疗效。方法对45例慢性化脓性中耳炎（胆脂瘤型31例,骨疡型14例）患者采用耳后切口,完成开放式乳突根治术后,乳突腔采用自体组织充填、Wullstein鼓室成形术、耳甲腔成形术。结果术后半年平均听力提高15dB（10~22dB）,骨气导差缩缩小16dB（8~20.5dB）。全部随访2~5年,平均3.8年,耳内镜检查术腔上皮化好,无痂皮堆积,27例鼓膜正常,5例有裂隙样穿孔,延迟愈合,9例鼓膜内陷,全都干耳,干耳率91.1%（41/45）。4例术后间隙流脓,再次完成同样手术后随访半年未再复发,这4例中3例胆脂瘤复发,复发率6.7%（3/45）;41例干耳时间6~9周,平均6.8周。结论慢性化脓性中耳炎（胆脂瘤型与骨疡型）采用开放式乳突根治术,术后乳突腔用自体组织充填、鼓室成形术,同时行耳甲腔成形术,能有效清除病灶,干耳率高,干耳时间短;术后听力提高,术腔上皮化好,疗效满意。

Objective To investigate the curative effect of autologous tissue to obliterate the mastoid cavity,conchaplasty and Wullstein Ⅲ tympanoplasty on chronic supurative otitis media.Methods Totally 45 cases of chronic supurative otitis media（cholesteatoma 31 cases and granulation tissue 14 cases） were treated with autologous tissue to obliterate the mastoid cavity,Wullstein Ⅲ tympanoplasty and conchaplasty after radical mostoidectomy through the retroauricular pathway.Results The 15dB（10~22dB） average improvement of auditory level and the 16DB（8~20.5dB） average decrease of A-B gap were achieved.After 2~5 years（3.8 years average） of follow-up,all cases examined by otoendoscope had a good epithelization in the surgical cavity and non-crust.Tympanic membranes were normal in 27 cases and had slit-shaped perforation in 5 cases in which healing were delayed.Drying ear rate was 91.1%（41/45）.4 ears which intermittently produced pus dried after second operation and 0.5 year of follow-up in which 3 ears is cholesteatoma.The rate of recurrence was 6.7%（3/45）.The course of dry ears（41 cases） took about 6-9weeks（average 6.8 weeks）.Conclusion The surgery operations of autologous tissue to obliterate the mastoid cavity,conchaplasty and Wullstein Ⅲ tympanoplasty on chronic supurative otitis media（cholesteatoma and/or granulation tissue） after radical mostoidectomy can clear up focus effectively,had the high rate of dry ear and short the duration for dry ear.The auditory level was improved,good epithelization was achieved and curative effect was satisfying.