软骨外耳道后壁重建术在Ⅲ期外耳道胆脂瘤手术中的应用

Application of Reconstruction of Posterior Wall of External Auditory Canal with Cartilagein for Stage Ⅲ External Auditory Canal Cholesteatoma

目的探讨软骨外耳道后壁重建术治疗外耳道后壁破坏乳突受侵的Ⅲ期外耳道胆脂瘤的效果。方法 2012年3月~2016年4月共收治11例12耳Ⅲ型外耳道胆脂瘤侵犯乳突患者。3耳骨质破坏范围大,行传统的开放式乳突切开+耳甲腔成形术;9耳病变局限,在彻底清除乳突病变后,取耳屏软骨行外耳道后壁重建术。结果 12耳均在术后获得干耳。3耳开放手术的干耳时间分别为50、58、65 d;9耳软骨外耳道后壁重建术干耳时间26~44 d,(33±5)d。11例随访6~53个月,(23±15)月,未见胆脂瘤复发,无外耳道塌陷及狭窄。结论对于Ⅲ期外耳道胆脂瘤,利用软骨行外耳道后壁重建术能够有效地在清除病变的同时重建外耳道形态,恢复其正常生理结构和功能,获得良好疗效。

Objective To discuss the curative effect and minimal invasive approach of reconstruction of posterior wall of external auditory canal with cartilagein for the surgical treatment of stage Ⅲ external auditory canal cholesteatoma（ EACC） with specific invasion in mastoid cavity. Methods A retrospective review was made on 11 cases（ 12 ears） of stage Ⅲ EACC with specific invasion in mastoid cavity from March 2012 to April 2016. Three ears suffered significant bone invasion,and were given traditional canal-wall-down（ CWD） mastoidectomy and auricular cavity forming. The other nine ears underwent reconstruction of posterior wall of external auditory canal with cartilage after complete elimination of the lesion. Results Dry ear was achieved after surgery in all the 12 ears. The patients got dry ear at 50,58,and 65 days after operation in the CWD group,and got dry ear at 26-44 days（ mean,33 ± 5 days） after reconstruction of posterior wall of external auditory canal. During a follow-up for 6- 53 months（ mean,23 ± 15 months）,there were no signs of recurrence of cholesteatoma and collapse or stenosis of external auditory canal.Conclusions For the treatment of stage Ⅲ EACC,reconstruction of posterior wall of external auditory canal is a minimal invasive approach with good curative results which effectively eliminates the lesion. Meanwhile,it achieves the reconstruction of shape of the external auditory canal and restores the normal physiological functions.