耳后带蒂肌筋膜瓣和耳屏软骨-软骨膜复合体在伴有开放式乳突根治Ⅲa型鼓室成形术中的应用

Combined application of postauricular muculofascial flap with pedicle and tragus cartilage-perichondrium complex in open mastoidectomy

目的探讨耳后带蒂肌筋膜瓣和耳屏软骨-软骨膜复合体在伴有开放式乳突根治的Ⅲa型鼓室成形术的应用价值。方法回顾性分析2009年2月至2010年9月在安徽省立医院耳鼻咽喉-头颈外科行中耳炎外科治疗的30例患者住院和术后随访资料。结果利用耳后带蒂肌筋膜瓣和耳屏软骨-软骨膜复合体修复鼓膜、上鼓室外侧壁和外耳道后壁缺损,其中,同时利用部分听骨赝复体质量建听骨链。30例患耳耳屏和耳后切口皆一期甲级愈合,移植物皆成活,外耳道无狭窄,干耳时间3～13周,中位数为6周。收集了25例患者的术前和术后纯音听阈测定资料,术前0.5、1.0、2.0和4.0 kHz纯音听阈均数(PTA)气骨导差值为8～36 dB,均数±标准差为(35±12)dB,术后PTA气骨导差值为8～28dB,均数±标准差为(20±10)dB,其中,术后PTA气骨导差值≤20 dB的有12例(48%),术后PTA气骨导差值缩小15 dB以上的有17例,占观察病例的68%。结论联合应用耳后带蒂肌筋膜瓣和耳屏软骨-软骨膜复合体行鼓膜修补及上鼓室外侧壁和外耳道后壁缺损,可以在彻底清除中耳病变的同时尽可能恢复外耳道和中耳形态,干耳率和移植物成活率高,大部分患者术后听力获得改善。

Objective To discuss the application value of postauricular muculofascial flap with pedicle and tragus cartilage –perichondrium complex in Ⅲa-type Tympanoplasty with open mastoidectomy.Method The clinical and follow-up data of 30 otitis media who had received surgical therapy in department of otolaryngology-head neck surgery of Anhui Provincial Hospital from february 2009 to september 2010 was analyzed retrospectively.Results The perforations of the tympanic membrane and the defects of the attic lateral wall and the posterior wall of the external auditory canal were repaired with postauricular musculofascial flap with pedicle and tragus cartilage –perichondrium complex.The tragus and postauricular incisions of all 30 patients healed in Ⅰstage with first rate.All of the implants survived.The time of ear-drying was between 3 to 13 weeks（median,6 weeks）.The data of 25 patients＇preoperation and postoperation pure-tone threshold tests were collected.The air-bone gaps of preoperation pure-tone threshold average（0.5、1.0、2.0 4.0kHz）were between 8dB to 36dB（35±12dB）;The air-bone gaps of postoperation pure-tone threshold average（0.5、1.0、2.0 4.0kHz）were between 8dB to 28dB（20±10dB）.There were 12 patients（48%）with a postoperation air-bone gap not more than 20dB.There were 17 patients（68%）with a air-bone gap decrease more than 15 dB.Conclusion With postauricular musculofascial flap with pedicle and tragus cartilage-perichondrium complex to repair tympanic membrane perforations and defects of the attic lateral wall and the posterior wall of the external auditory canal,the ear-drying rate and the implant survival rate are high and most of the patients with otitis medea can get a improved hearing level postoperatively.