本文選題：先天性畸形 + 先天性外耳道閉鎖　； 參考：《福建醫(yī)科大學》2013年碩士論文

【摘要】：目的:探討先天性外耳道閉鎖及狹窄的手術方法、并發(fā)癥的防治及影響手術效果的相關因素等，使該病的診治更趨合理和規(guī)范。 方法：采取回顧性分析方法對1991年1月～2012年12月間（22年）在我科接受手術治療、住院資料完整的先天性外耳道閉鎖（congenitalacousticatresia，CAA）或狹窄的患者39例(手術耳43耳)進行病史查閱、影像學檢查資料閱讀分析等，將手術耳分為耳廓畸形+外耳道完全閉鎖(閉鎖組)、耳廓畸形+外耳道狹窄(狹窄組)兩組，并將耳廓畸形按Marx分類分為三度。43耳中5耳僅行外耳道成形術，4耳行外耳道成形+鼓室開放術，其余的34耳行外耳道成形術+鼓室成形術。 結果:所有病例中除5例（均為單側畸形患者）失訪外，其余34例（38耳）患者術后隨訪0.5～1.5年。隨訪的34例（38耳）中有9耳（23.68%）于術后4月～8月出現(xiàn)外耳道狹窄或閉鎖而需行外耳道成形術或外耳道肉芽搔刮術，其中1耳拒絕再次手術，再次手術的8耳均恢復良好；3耳次術后出現(xiàn)鼓膜外側愈合，聽力提高不理想，均因另耳聽力尚可而拒絕再次手術；術后5耳次出現(xiàn)術腔感染或不干耳；術后3例（均為單側患者）出現(xiàn)暫時性面癱，經保守治療1～3月后完全恢復。術后半年復查純音聽閾，氣導語言頻率平均聽力提高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%)，，未出現(xiàn)感音神經性耳聾并發(fā)癥。 結論:1.外耳道中耳成形術是先天性外耳道閉鎖或狹窄的有效治療方法，患耳畸形程度、手術方式、術后并發(fā)癥及其處理方式是影響其療效的重要因素； 2.術前全面評估患耳畸形程度、選擇最佳方式的鼓室成形及術后并發(fā)癥的有效防治是提高療效的關鍵； 3.游離中厚皮片移植、植皮成形后的外耳道腔足夠大、術后保持適當時間的外耳道擴張等是避免術后外耳道再狹窄或閉鎖的關鍵； 4.外耳道閉鎖或狹窄與耳廓畸形程度無明顯關聯(lián)，本研究的此結果與文獻報道有差異，可能與樣本數(shù)不夠有關。
[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

本文編號：1771679