耳廓软骨在乳突根治术外耳道后壁修复及鼓室成形中的应用

The application of autologous cartilago auriculae in posterior wall of external auditory canal reconstruction and tympanoplasty

目的：探讨耳廓软骨在开放式乳突根治术外耳道后壁重建及鼓室成形中的临床价值。方法：随机分配我科于2011-09-2014-09期间收治的58例（耳）胆脂瘤中耳炎患者,其中男31耳,女27耳;年龄20~62岁,平均（43.16±9.43）岁。各29例分别行开放式乳突根治术,对照组术中单纯使用自体乳突皮质骨粉作乳突术腔填充、肌骨膜瓣修复外耳道后壁及自体颞肌筋膜修补鼓膜,试验组加用带软骨膜的耳廓软骨行外耳道后壁及鼓室重建,比较两组术后新鼓膜情况、干耳时间及术后3、6个月听力改善情况。结果：2组患者在鼓膜状态、干耳时间、听力提高等方面差异有统计学意义（P〈0.05）,试验组明显优于对照组,2组患者在随访期内均未发现胆脂瘤复发。结论：以收集的乳突皮质骨粉作为填充物,运用带软骨膜的耳廓软骨行外耳道后壁及鼓室重建,能获得更符合生理结构状态的外耳道及容积接近正常水平的鼓室,干耳及听力改善情况满意,是适合开放式乳突根治术的修复材料。

Objective：To evaluate the value of of autologous cartilago auriculae in posterior wall of external auditory canal reconstruction and tympanoplasty after modified radical mastoidectomy.Method：To determine the outcome of surgery for chronic suppurative otitis media with choleteatoma.The open mastoidectomy and tympanoplasty were performed on sixty patients aged 20-62 years old,and the average age was（43.16±9.43）years old,which includes 31 males and 27 females at our department in the period from September 2011 to September 2014.58 patients all underwent modified radical mastoidectomy.Study group chose collected intraoperative cortical mastoid bone as a filler combined with autologous cartilago auriculae and temporal fascia muscle-periosteal flap covering the cavity and tympanoplasty.Control group chose collected intraoperative cortical mastoid bone as a filler temporal fascia muscle-periosteal flap covering the cavity.The hearing improvement at the time of achieving dry ear,3months and 6months after surgery were evaluated for both groups.Result：There are significant differeence between two groups in improvement of hearing and dry ear time,according to follow-up and analysis of therapeutic efficacy（P〈0.05）,There was no recurrence of cholesteatoma in 2groups.Conclusion：The application of autologous cartilago auriculae in posterior wall of external auditory canal reconstruction and tympanoplastycan that can get more in line with the external auditory canal and the volume of physiological structure state of near normal tympanic cavity,dry ear and hearing improvement was satisfied.The autologous cartilago curiculae is suitable for repairing materials of open radical operation.