鼓室成形术中上鼓室及乳突区病灶清除后的修复处理

The Management of Attic and Mastoid Cavity after Atticotomy and Mastoidectomy in Tympanoplasty

目的探讨鼓室成形术中骨皮质骨粉在上鼓室及乳突区病灶清除后修复处理中的应用。方法对58例行开放式鼓室成形术患者的资料进行回顾性分析。术中应用乳突骨皮质骨粉充填乳突术腔和上鼓室腔,保护暴露的脑膜,加用颞肌筋膜保护裸露的面神经和修复半规管瘘。用颞肌筋膜修复鼓膜并覆盖于充填乳突腔的骨粉表面。结果应用骨粉处理乳突术腔和上鼓室腔术后干耳较早,术后3个月干耳率达到93.1%(54/58),6个月达到98.3%(57/58),耳道宽畅平滑光整。保护脑膜和面神经的病例无面瘫和脑膜炎症状发生,半规管瘘修复患者术后眩晕症状短期内消失。结论骨皮质骨粉在上鼓室及乳突区病灶清除后的处理中是良好的充填及保护材料,有利于术后早期干耳。

Purpose To discuss the application of bone pate from mastoid cortex for construction of attic and mastoid cavity after atticotomy and mastoidectomy in canal wall down tympanoplasty. Methods The data of 58 patients treated by tympanoplasty were retrospectively analyzed. The bone pate collected while drilling the mastoid cortex was used to fill in the attic cell and mastoid cavity after atticotomy and mastoidectomy, and also used to protect the exposed endocranium. The labyrinthine fistuke and naked facial nerve were overlapped with temporalis fascia first and then covered with bone pate. The temporalis fascia was used to repair eardrum and overlap the surface of bone pate. Results Most patients had dry ears with slightly wide and smooth external canal shortly after the operation. The rate of dry ear in three months was 93 A % (54/58) , and rose to 98.3% (57/58) in six months. There were no symptoms of facial paralysis and meningitis in these patients. And the vertigo of patients with labyrinthine fistulae vanished fast. Conclusion Bone pate from mastoid cortex is a good filling and protective material used in attic and mastoid cavity construction in tympanoplasty. It can help to obtain dry ear early.