外耳道后壁重建治疗难治性中耳残腔炎的疗效观察

发布时间：2018-05-15 01:20

本文选题：中耳 + 残腔炎　；参考：《临床耳鼻咽喉头颈外科杂志》2017年16期

【摘要】：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。
[Abstract]:Objective: to observe the effect of reconstruction of posterior wall of external auditory canal on refractory middle ear residual cavity inflammation. Methods: on the basis of thoroughly removing the residual lesions of middle ear and mastoid process, 5 cases of refractory postoperative residual cavity inflammation were treated with hydroxyapatite ceramics (HA) as the stents for the posterior wall of external auditory canal. The posterior wall of the external auditory canal was reconstructed by the transfer of pedicled temporal fascia to reconstruct the posterior wall of the external auditory canal. Tympanoplasty was performed during the operation. Results all of the 5 patients were able to dry ear 3 months after operation, 3 of them had improved hearing, 1 case had no change in hearing within 20dB, 1 case had hearing loss, 3 cases had complete epithelialization of the posterior wall of external auditory canal, 1 case had partially exposed HA center. The peripheral part was epithelialized, the external auditory canal was not connected with the mastoid cavity, and the cholesteatoma of the tympanic cavity was found to recur after 1 year of CT reexamination. The cholesteatoma was cleared after correction and on the basis of preserving the reconstructed posterior wall of the external auditory canal. There was no recurrence of cholesteatoma 3 months after operation in another case, the fistula occurred between the lateral skin of the external auditory canal and the posterior wall of the reconstructed external auditory canal, and the fistula was repaired by the musculoperiosteal flap again. The fistula was repaired and the posterior wall of the external auditory canal was epithelized 3 months after operation. All the patients had no postoperative complications such as facial paralysis and stenosis of external auditory canal. Conclusion the reconstruction of the posterior wall of the external auditory canal with the transfer pedicle of the temporal fascia is one of the effective methods for the treatment of refractory middle ear residual cavity inflammation, and it is worth popularizing.
【作者单位】：首都医科大学附属北京友谊医院耳鼻咽喉头颈外科;
【分类号】：R764.9

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