先天性外耳道闭锁的外科治疗

发布时间：2018-04-19 05:05

  本文选题：先天性畸形 + 先天性外耳道闭锁　； 参考：《福建医科大学》2013年硕士论文

【摘要】：目的:探讨先天性外耳道闭锁及狭窄的手术方法、并发症的防治及影响手术效果的相关因素等，使该病的诊治更趋合理和规范。 方法：采取回顾性分析方法对1991年1月～2012年12月间（22年）在我科接受手术治疗、住院资料完整的先天性外耳道闭锁（congenitalacousticatresia，CAA）或狭窄的患者39例(手术耳43耳)进行病史查阅、影像学检查资料阅读分析等，将手术耳分为耳廓畸形+外耳道完全闭锁(闭锁组)、耳廓畸形+外耳道狭窄(狭窄组)两组，并将耳廓畸形按Marx分类分为三度。43耳中5耳仅行外耳道成形术，4耳行外耳道成形+鼓室开放术，其余的34耳行外耳道成形术+鼓室成形术。 结果:所有病例中除5例（均为单侧畸形患者）失访外，其余34例（38耳）患者术后随访0.5～1.5年。随访的34例（38耳）中有9耳（23.68%）于术后4月～8月出现外耳道狭窄或闭锁而需行外耳道成形术或外耳道肉芽搔刮术，其中1耳拒绝再次手术，再次手术的8耳均恢复良好；3耳次术后出现鼓膜外侧愈合，听力提高不理想，均因另耳听力尚可而拒绝再次手术；术后5耳次出现术腔感染或不干耳；术后3例（均为单侧患者）出现暂时性面瘫，经保守治疗1～3月后完全恢复。术后半年复查纯音听阈，气导语言频率平均听力提高20dB以上者19耳(50%），其中提高≥30dB者7耳(18.42%),提高≥40dB者1耳(2.63%)，，未出现感音神经性耳聋并发症。 结论:1.外耳道中耳成形术是先天性外耳道闭锁或狭窄的有效治疗方法，患耳畸形程度、手术方式、术后并发症及其处理方式是影响其疗效的重要因素； 2.术前全面评估患耳畸形程度、选择最佳方式的鼓室成形及术后并发症的有效防治是提高疗效的关键； 3.游离中厚皮片移植、植皮成形后的外耳道腔足够大、术后保持适当时间的外耳道扩张等是避免术后外耳道再狭窄或闭锁的关键； 4.外耳道闭锁或狭窄与耳廓畸形程度无明显关联，本研究的此结果与文献报道有差异，可能与样本数不够有关。
[Abstract]:Objective: to investigate the operative methods of atresia and stenosis of congenital external auditory canal, the prevention and treatment of complications and the related factors affecting the surgical effect, so as to make the diagnosis and treatment of the disease more reasonable and standardized.Methods: the history of 39 cases (43 ears) with congenital atresia of external auditory canal (CAA) or stenosis (43 ears) received surgical treatment in our department from January 1991 to December 2012 (22 years) was retrospectively analyzed.The operative ears were divided into two groups: complete atresia (atresia group) and stenoses (stenosis group) in auricle malformation.According to the classification of Marx, the auricle deformity was divided into 3 degrees and 43 ears. 5 ears were treated with external meatus plasty and 4 ears were treated with open tympanoplasty of external auditory meatus, the other 34 ears were treated with tympanoplasty.Results: all the patients were followed up for 0.5 ~ 1.5 years except 5 cases (all unilateral deformity patients) and 34 cases (38 ears).Of the 34 cases (38 ears), 9 ears (23.68 ears) had stenosis or atresia of the external auditory canal from 4 to 8 months after operation, which required external meatus angioplasty or curettage of the external auditory canal. One ear refused to undergo another operation.All the 8 ears of the second operation recovered well and 3 ears had the lateral healing of tympanic membrane after operation, but the hearing improvement was not satisfactory, and all the ears refused to operate again because of the hearing ability of the other ear, 5 times after operation, 5 ears had infection in the operative cavity or did not dry the ear.Temporary facial palsy occurred in 3 cases (all unilateral patients) and recovered completely after 1 ~ 3 months of conservative treatment.Half a year after operation, the hearing threshold of pure tone was reexamined. The average hearing frequency of air conduction language increased more than 20dB in 19 ears (50 ears), in which 7 ears increased 鈮

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