先天性小耳畸形功能与形态的一期重建

发布时间：2018-07-12 16:12

  本文选题：先天性小耳畸形 + 听力重建　； 参考：《上海交通大学》2013年博士论文

【摘要】：背景:先天性小耳畸形是一种不明原因引起的胚胎第一、二鳃弓和第一鳃沟的发育异常而导致的耳郭畸形,多数伴有外耳道闭锁和听觉功能障碍,部分伴颌面部畸形,我国有较高的发病率。以往的治疗多只注重外形的重建而忽视听觉功能的重建,或二者只取其一,也有分期进行重建的。本研究拟在以往研究的基础上,对先天性小耳畸形进行形态与听觉功能的一期重建。目的:探讨先天性小耳畸形耳郭形态与听觉功能一期重建的可行性和术后耳郭形态和听觉功能恢复的临床效果。方法:将2011年1月起来上海交通大学医学院附属第九人民医院就诊的先天性小耳畸形伴外耳道闭锁的患者38例随机分为实验组和对照组,每组19例20耳,术前均签署知情同意书。实验组行Medpor支架植入全耳郭再造术加同期听力重建术。其中实验组病例先行颞骨薄层CT扫描和Jahrsdoerfer CT评分,评分≥6分者入实验A组,听力重建方式为外耳道成形术和鼓室成型术;评分≤5分者入实验B组,听力重建方式为BAHA植入术。对照组仅行Medpor支架植入全耳郭再造术。术后分别于3、6、12、24M对手术后的临床效果进行评估,包括手术的成功率、耳郭的对称度、耳郭精细结构显示、患者的满意度和听力康复情况。结果:所有病例40耳手术均成功,1耳(实验组)于术后8M因外伤而致局部支架外露,予以局部组织瓣修复后随访6M未再外露,18耳行外耳道成形术者有2例发生术后再狭窄和闭锁,占11.11%,未发生包括面瘫在内的其它并发症。对耳郭的7个对称度指标进行评分,实验组和对照组均在5分以上,两组间无明显差异;对耳郭的14个精细结构进行评分,≥10分,实验组17/20耳(85%),对照组15/20耳(75%),p=0.429,组间无差异;≥12分,实验组15/20耳(75%),对照组8/20耳(40%),p=0.025(0.05),差异有显著性。患者的满意度分析显示总满意率两组均为95%,无差异;满意率(很满意和满意)实验组85%,对照组60%,实验组高于对照组,但由于样本量较小,差异尚无显著性(p=0.077)。实验组20耳进行了同期听力重建,18/20耳(90%)听力得到了提高,平均气导提高22.3d B。结论:先天性小耳畸形耳郭形态与听觉功能一期重建临床上安全可行,它不仅可以在再造耳郭的同时取得较好的听力康复效果,同时也可以使再造耳郭在形态上更加逼真,提高患者的满意率。同时,由于带蒂颞筋膜瓣等参与外耳道的重建,可以有效降低外耳道术后的再狭窄率。
[Abstract]:Background: congenital microauricle malformation is a deformity of the auricle caused by abnormal development of the first, second branchial arch and the first branchial sulcus of the embryo, most of which are accompanied by atresia of external auditory canal and auditory dysfunction, and some of them are accompanied by maxillofacial malformation. There is a high incidence of disease in China. In the past, most of the treatments only focus on the reconstruction of appearance and ignore the reconstruction of auditory function, or only one of them is reconstructed by stages. Based on previous studies, this study aims to reconstruct the shape and auditory function of congenital microauricular malformation. Objective: to investigate the feasibility of primary reconstruction of auricle shape and auditory function in congenital microauricular malformation and the clinical effect of recovery of auricle shape and auditory function after operation. Methods: a total of 38 patients with congenital microtia with external auditory atresia were randomly divided into experimental group (n = 19, n = 20) and control group (n = 19, n = 20) from January 2011 to January 2011, the ninth people's Hospital affiliated to Shanghai Jiaotong University Medical College. Informed consent was signed before operation. The experimental group was treated with Medpor stent implantation total auricle reconstruction and simultaneous hearing reconstruction. In the experimental group, thin-slice CT scan of temporal bone and Jahrsdoerfer CT score were performed first. The patients with score 鈮，

本文编号：2117715