發(fā)布時(shí)間：2018-07-12 16:12

  本文選題：先天性小耳畸形 + 聽力重建�。� 參考：《上海交通大學(xué)》2013年博士論文

【摘要】：背景:先天性小耳畸形是一種不明原因引起的胚胎第一、二鰓弓和第一鰓溝的發(fā)育異常而導(dǎo)致的耳郭畸形,多數(shù)伴有外耳道閉鎖和聽覺功能障礙,部分伴頜面部畸形,我國有較高的發(fā)病率。以往的治療多只注重外形的重建而忽視聽覺功能的重建,或二者只取其一,也有分期進(jìn)行重建的。本研究擬在以往研究的基礎(chǔ)上,對(duì)先天性小耳畸形進(jìn)行形態(tài)與聽覺功能的一期重建。目的:探討先天性小耳畸形耳郭形態(tài)與聽覺功能一期重建的可行性和術(shù)后耳郭形態(tài)和聽覺功能恢復(fù)的臨床效果。方法:將2011年1月起來上海交通大學(xué)醫(yī)學(xué)院附屬第九人民醫(yī)院就診的先天性小耳畸形伴外耳道閉鎖的患者38例隨機(jī)分為實(shí)驗(yàn)組和對(duì)照組,每組19例20耳,術(shù)前均簽署知情同意書。實(shí)驗(yàn)組行Medpor支架植入全耳郭再造術(shù)加同期聽力重建術(shù)。其中實(shí)驗(yàn)組病例先行顳骨薄層CT掃描和Jahrsdoerfer CT評(píng)分,評(píng)分≥6分者入實(shí)驗(yàn)A組,聽力重建方式為外耳道成形術(shù)和鼓室成型術(shù);評(píng)分≤5分者入實(shí)驗(yàn)B組,聽力重建方式為BAHA植入術(shù)。對(duì)照組僅行Medpor支架植入全耳郭再造術(shù)。術(shù)后分別于3、6、12、24M對(duì)手術(shù)后的臨床效果進(jìn)行評(píng)估,包括手術(shù)的成功率、耳郭的對(duì)稱度、耳郭精細(xì)結(jié)構(gòu)顯示、患者的滿意度和聽力康復(fù)情況。結(jié)果:所有病例40耳手術(shù)均成功,1耳(實(shí)驗(yàn)組)于術(shù)后8M因外傷而致局部支架外露,予以局部組織瓣修復(fù)后隨訪6M未再外露,18耳行外耳道成形術(shù)者有2例發(fā)生術(shù)后再狹窄和閉鎖,占11.11%,未發(fā)生包括面癱在內(nèi)的其它并發(fā)癥。對(duì)耳郭的7個(gè)對(duì)稱度指標(biāo)進(jìn)行評(píng)分,實(shí)驗(yàn)組和對(duì)照組均在5分以上,兩組間無明顯差異;對(duì)耳郭的14個(gè)精細(xì)結(jié)構(gòu)進(jìn)行評(píng)分,≥10分,實(shí)驗(yàn)組17/20耳(85%),對(duì)照組15/20耳(75%),p=0.429,組間無差異;≥12分,實(shí)驗(yàn)組15/20耳(75%),對(duì)照組8/20耳(40%),p=0.025(0.05),差異有顯著性。患者的滿意度分析顯示總滿意率兩組均為95%,無差異;滿意率(很滿意和滿意)實(shí)驗(yàn)組85%,對(duì)照組60%,實(shí)驗(yàn)組高于對(duì)照組,但由于樣本量較小,差異尚無顯著性(p=0.077)。實(shí)驗(yàn)組20耳進(jìn)行了同期聽力重建,18/20耳(90%)聽力得到了提高,平均氣導(dǎo)提高22.3d B。結(jié)論:先天性小耳畸形耳郭形態(tài)與聽覺功能一期重建臨床上安全可行,它不僅可以在再造耳郭的同時(shí)取得較好的聽力康復(fù)效果,同時(shí)也可以使再造耳郭在形態(tài)上更加逼真,提高患者的滿意率。同時(shí),由于帶蒂顳筋膜瓣等參與外耳道的重建,可以有效降低外耳道術(shù)后的再狹窄率。
[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，

本文編號(hào)：2117715