摘要
目的探讨耳内镜下耳屏软骨-软骨膜重建外耳道后壁或上鼓室外侧壁的临床应用及术后效果。方法回顾性分析2015年8月~2019年8月期间住院手术的52例(52耳)外耳道及中耳胆脂瘤患者的临床资料,病变均累及上鼓室及鼓窦,其中45例为中耳胆脂瘤,7例为外耳道胆脂瘤,均在耳内镜下行上鼓室开放术同期行鼓室成形,术中用耳屏软骨-软骨膜重建上鼓室外侧壁或外耳道后壁,分析手术技术要点、观察术后干耳时间、鼓膜愈合、上鼓室外侧壁塌陷及听力疗效等相关情况。结果52例(52耳)术后平均随访时间26.3±7.2个月,术后平均干耳时间27.5±8.8天;鼓膜完全愈合47耳(90.4%,47/52),其中鼓膜完全愈合且形态正常41耳(78.8%,41/52),鼓膜愈合但内陷6耳(11.5%,6/52);复发5耳(9.6%,5/52),其中紧张部内陷穿孔1耳(1/52,1.9%),松弛部内陷伴穿孔4耳(4/52,7.7%);无一例面瘫和外耳道狭窄。术后12个月,0.5、1、2、4 kHz平均气导听阈(32.1±5.8 dB HL)较术前(53.2±10.4 dB HL)明显降低(P<0.001),ABG(15.6±7.6 dB)值较术前(41.5±7.4 dB)明显降低(P<0.001)。结论对于累及上鼓室的外耳道或中耳胆脂瘤,可经耳内镜行上鼓室开放术清除病变,用耳屏软骨-软骨膜重建上鼓室外侧壁或外耳道后壁,依靠软骨的支撑,可维持鼓室、鼓窦及乳突腔含气腔,减少鼓膜松弛部内陷的发生,保持上鼓室外侧壁的基本形态。
Objective To explore the clinical application and postoperative effect of lateral attic wall reconstructed by tragal cartilage and perichondrium with endoscopic ear surgery.Methods From Aug 2015 to Aug 2019,52 patients whose middle ear lesions were limited to attic received this surgery in our department.A total of 45 cases of cholesteatoma otitis media and 7 cases of external auditory canal cholesteatoma were included.In order to expose the attic fully,we operated epitympanotomy and then removed the scutum and lateral attic bone wall.After eliminating the lesions,we reconstructed the attic bone wall with tragal cartilage and perichondrium.Postoperative follow-ups were conducted and the main points of surgical techniques were summarized to observe the postoperative dry ear time,tympanic membrane healing,lateral attic wall collapse and hearing.Results The average follow-up time was 26.3±7.2 months.Postoperative correlation average dry ear time(27.5±8.8)d;The tympanic membrane was completely healed(47/52,90.38%),the tympanic membrane was completely healed and the shape was normal in 41 ears(41/52,78.8%),the tympanic membrane was healed but recessed in 6 cases(6/52,11.5%),Recurrence was observed in 5 cases(5/52,9.6%),membranae tensa was recessed and perforated in 1 case(1/52,1.9%),and pars flaccida was recessed and perforated in 4 ears(4/52,7.7%).Facial paralysis(0/52,0.00%);external auditory canal stenosis(0/52,0.0%)were not opsewed.At 12 months after surgery,the mean threshold of 0.5,1,2 and 4kHz was statistically significant(32.13±5.82dB HL,53.2±10.4dB HL,P=0.000,P<0.01),and ABG was statistically significant(15.6±7.6dB HL,41.5±7.4dB HL,P=0.000,P<0.01).Conclusion With regard to cholesteatoma of the attic,we can remove it by operating epitympanotomy with endoscopic ear surgery,and then reconstruct the lateral attic wall with tragal cartilage and perichondrium.By the support of the cartilage,we can keep the epitympanic aeration,reduce the retraction of pars flaccida and maintain the fundamental shape of lateral attic wall.
作者
王涛
瞿申红
唐凤珠
唐杰
桂志
莫锦营
李春玲
Wang Tao;Qu Shenhong;Tang Fengzhu;Tang Jie;Gui Zhi;Mo Jingyin;Li Chunling(Department of Otorhinolaryngology Head and Neck Surgery,Guangxi Zhuang Autonomous Region People's Hospital,Nanning,530021 China)
出处
《听力学及言语疾病杂志》
CAS
CSCD
北大核心
2021年第4期406-410,共5页
Journal of Audiology and Speech Pathology
关键词
耳屏软骨
软骨膜
上鼓室外侧壁
胆脂瘤
Tragal cartilage
Perichondrium
Lateral attic wall
Cholesteatoma
