带蒂颞肌筋膜重建外耳道后壁及鼓室成形术

Reconstruction of posterior wall of external auditory canal and tympanoplasty using pedicled temporalis myofascia

目的探讨采用带蒂颞肌筋膜重建外耳道后壁及鼓室成形术治疗胆脂瘤中耳炎的初步临床疗效。方法选择74例胆脂瘤中耳炎,在改良乳突根治的基础上,39耳以带蒂颞肌筋膜蒂部重建外耳道后壁、筋膜部修补鼓膜,为重建组;35耳以游离颞肌筋膜修补鼓膜,为开放组。比较两组术后疗效。结果术后随访2～4年,重建组随访37例,外耳道接近正常,筋膜成活率97.29%,复发率5.6%。开放组随访33例,外耳道宽大畸形,筋膜成活率93.93%,复发率6.3%。两组手术前、后语频区(0.5、1、2、4 kHz)骨气导差缩小值,重建组分别为(15.3±0.33)、(15.1±0.30)、(15.6±0.25)、(20.5±1.34)dB;开放组分别为(13.8±0.36)、(13.5±0.43)、(13.4±0.42)、(14.6±0.76)dB,差异有统计学意义。结论耳后带蒂颞肌筋膜重建外耳道后壁及鼓室成形术治疗胆脂瘤中耳炎,术后干耳时间短,外耳道接近正常,修补物成活率高,术后骨气导差缩小显著,复发率低。

OBJECTIVE To investigate the preliminary clinical effects of Reconstruction of Posterior Wall of External Auditory Canal（EAC）and tympanoplasty using Pedicled Temporalis Myofascia in the treatment of cholesteatoma otitis media.METHODS74 patients（74 ears）with cholesteatoma otitis media were selected and underwent radical mastoidectomy for basic,39 ears of which were underwent reconstruction of posterior wall of external auditory canal and tympanoplasty using pedicled temporalis myofascia which named reconstruction group,the other 35 ears were underwent tympanoplasty with dissociative temporalis myofascia which named canal wall down group.Compared the postoperative effects of the two groups.RESULTS 37 ears in reconstruction group were followed-up for 2-4 years,the EAC remained in normal position,the myofascia survival rate was 97.29% and the recurrence rate was 5.6%;Meanwhile 33 ears in canal wall down group showed an deformed EAC,the myofascia survival rate was 93.93% and the recurrence rate was 6.3%.The reduction of the air-bone gap（ABG） in 0.5、1、2、4 kHz frequency was compared before and after the surgery.The reconstruction group were（15.3±0.33）、（15.1±0.30）、（15.6±0.25）、（20.5±1.34）dB respectively,the canal wall down group were（3.8±0.36）、（13.5±0.43）、（13.4±0.42）、（14.6±0.76）dB respectively,which showed significant difference.CONCLUSION Using the pedicled temporalis myofascia to reconstruct the posterior canal wall and tympanoplasty in the treatment of cholesteatoma otitis media can shorten the drying time,approximately remain a normal EAC,heighten the survival rate of the myofascia,significantly shorten the air-bone gap and reduce the recurrence rate of the cholesteatoma.