外耳道后壁重建治疗难治性中耳残腔炎的疗效观察

Clinical observation on the treatment of intractable otomastoiditis with reconstruction of external auditory canal wall

目的:观察外耳道后壁重建治疗难治性中耳残腔炎的疗效。方法:对5例难治性术后残腔炎患者在彻底清除中耳乳突残留病灶的基础上,用羟基磷灰石陶瓷(HA)作外耳道后壁支架,并转移带蒂颞肌筋膜覆盖在移植物表面以重建外耳道后壁,视术中鼓室探查状况行鼓室成形术,术后1、3、6、12个月定期复查。结果:5例患者术后3个月均能干耳,其中3例听力提高,气骨导差在20dB之内;1例听力无变化;1例患者听力下降。3例患者外耳道后壁完全上皮化;1例HA中心部分裸露,周边部分均已上皮化,外耳道不与乳突腔相通,且术后1年复查CT时发现其鼓室胆脂瘤复发,经过修正手术并且在保留重建的外耳道后壁的基础上清理胆脂瘤,术后复查胆脂瘤未再复发;另外1例术后3个月外耳道近外侧皮肤与重建外耳道后壁之间出现瘘道,再次手术予以肌骨膜瓣修补瘘道,术后3个月复查瘘道修复且外耳道后壁均上皮化。全部患者均未出现面瘫、外耳道狭窄等术后并发症,所有患者对手术效果表示满意。结论:HA加转移带蒂颞肌筋膜重建外耳道后壁是治疗难治性中耳残腔炎的有效方法之一,值得推广。

Objective：To observe the clinical effect on the treatment of intractable tympanitis with reconstruction of external auditory canal wall.Method：Five cases underwent radical removel of residual lesion and reconsruction of external auditory posterior canal wall using hydroxyapatite ceramic wall with transferred pedicle temporalis fascia covering on it were analyzed.The implement of ossicular chain reconstruction depends on the probing for tympanic cavity intraoperatively.Periodic review were conducted in the 1st,3rd,6th,12th month after surgery.Result：All 5cases gained dryears within 3months after surgery,in which hearing of 3 cases improved and ABG were within 20dB;1cases showed no improvement compared to preoperation;and 1case gained a worse audiology result.Central part of the transplant of 1 case was naked,while peripheral part had been epithelization and external auditory canal gained no accessible to mastoid cavity,the patient were also found recurrence of cholesteatom inside the mastoid cavity when recived CT examination during outpatient follow-up one year postoperatively,and underwent correction surgery.1case underwent revision operation for a fistula between the reconstructed wall and the skin of the outer auditory canal.No surgical complications like infection or facial paralysis occurred,all patients were satisfied with surgery effect.Conclusion：HA with transferred vascularized temporalis fascia pedicle for the reconstructon of the external auditory canal wall is an effective method for the treatment of intractable tympanitis,and worth promoting.