骨片重建和围手术期通气治疗根治腔的效果观察

Reconstruction of ear canal wall with periosteo-bone graft and postoperative mastoid cavity inflation for huge radical cavity after mastoidectomy

目的探讨利用自体带骨膜的骨皮质片，修复根治后遗留的巨大腔并作听骨重建，及术后使用乳突腔充气的治疗效果。方法回顾性分析40例手术病历资料（再次手术3例，共43例次），均有胆脂瘤根治手术根治腔和感染流脓。术前平均气导（68．27±14．13）dBHL（AC，取0．5K，1K，2K均数，下同），平均气骨导差（GAP）（47．02±12．72）dBHL。按照手术方法，分两组：骨片组，前20耳带骨膜骨片修复根治腔和听骨重建；充气组，另23耳（其中3耳是骨片组再手术）在前述基础上引出2mm硅胶管，在术后围手术期中加用中耳充气。随访6～60个月，平均（16．46±8．36）个月，平均气骨导差（GAP）〈20dB为成功。统计分析用U检验。结果耳道情况：40例全部耳道呈现光滑的外观。8例有随访的CT片复查，呈现上鼓室和／或乳突腔再气化；听力结果：27例（62％）为成功，16例为显效（37％）。骨片组3例术后听力不佳，再次手术中发现均有中上鼓室间粘连，分解后使用充气法，2例获成功。结论带骨膜骨片有助于形成正常光滑的耳道，中耳充气有利于上鼓室再气化和听力恢复。

Objective To investigate the effectiveness of defect repair of ear canal with autologous periosteo-bone graft and postoperative mastoid cavity inflation. Methods Clincal data of 43 cases （40 patients ） were reviewed. All patients underwent radical mastoidectomy before. The mean pre-operative air conduction （AC） was 68.27 ± 14. 13 dBHL, and the mean GAP was 47.02 ±12.72 dBHL. These cases were further divided into two groups： a） 20 cases received ear ossicle remodeling surgery and the radical mastoid cavity was repaired by periosteo-bone graft; b） The oth- er 23 cases（ among them, 3 cases from the former group were re-operated ）received additional postoperative mastoid cavity inflation twice per day. Follow-up lasted 9-60 months （ mean 16.46 ±8.36 months）. Results All ear canals recovered with smooth appearance. In eight cases, postoperative CT scans showed re-gasification of attic and/or mas- toid cavity. Compared with the preoperative, postoperative mean AC and GAP were 47.02 ±12.72 and 23.04 ± 15.30 dBHL, respectively （both P 〈0.01 ）. The effective rate was 62% （27 cases） and mild effective rate was 37%. In the 3 cases reoperated, poor postoperative hearing were noted and the adhesion located between the mesotympanum and at- tic. After the revising surgery, 2 cases gained satisfying GAP. Conclusion Bone graft containing periosteum can be used to reconstruct the ear canal. Auxiliary inflation of middle ear can promote the attic and/or mastoid cavity re-gasifi- cation and hearing recovery.