【摘要】： 目的:探討開放式乳突切開應(yīng)用耳后肌骨膜瓣行軟壁外耳道重建鼓室成形術(shù)治療膽脂瘤中耳炎的療效。 方法:觀察2005年1月至2009年9月行開放式乳突切開軟壁外耳道重建鼓室成形術(shù)治療膽脂瘤中耳炎的療效,對資料完整的60例(61耳)進(jìn)行分析。該術(shù)式不行耳甲腔成形術(shù),保留正常外耳道皮膚的完整結(jié)構(gòu),以耳后肌骨膜瓣重建軟壁外耳道,術(shù)中根據(jù)病變情況行Ⅲa型和Ⅲb型鼓室成形術(shù)。觀察術(shù)后干耳時間,外耳道的形態(tài)和功能,聽力變化,有無膽脂瘤復(fù)發(fā)及其它并發(fā)癥。采用自身術(shù)前與術(shù)后對照,進(jìn)行聽力學(xué)評價,應(yīng)用配對t檢驗(yàn)。 結(jié)果:術(shù)后隨訪6～24個月,平均干耳時間為21.4±2.6天。術(shù)后外耳道形態(tài)基本正常,具備正常功能,不需經(jīng)常清理結(jié)痂。術(shù)后平均氣導(dǎo)聽閾為39.6±8.2 dBHL,術(shù)前平均氣導(dǎo)聽閾53.8±6.8 dBHL,差異有統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后平均氣骨導(dǎo)差26.0±6.8 dBHL,術(shù)前平均氣骨導(dǎo)差40.6±5.6 dBHL,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。以術(shù)后語言頻率氣骨導(dǎo)差縮小大于或等于10dB為手術(shù)有效標(biāo)準(zhǔn),48耳有效,有效率為78.7 %(48/61)。無膽脂瘤復(fù)發(fā),無肌骨膜瓣萎縮、壞死等并發(fā)癥。 結(jié)論:開放式乳突切開應(yīng)用耳后肌骨膜瓣行軟壁外耳道重建鼓室成形術(shù),能使外耳道的形態(tài)和功能基本恢復(fù)正常,無需行耳甲腔成形術(shù),聽力恢復(fù)滿意。本研究重視保留外耳道的形態(tài)和功能,符合當(dāng)代微創(chuàng)和功能外科的理念和發(fā)展方向。實(shí)踐表明重建軟壁外耳道使之接近于生理狀態(tài)是可行的。
[Abstract]:Objective: to investigate the effect of open mastoidotomy with periosteum flap of posterior auricular muscle for tympanoplasty with soft wall external auditory canal reconstruction in the treatment of cholesteatoma otitis media. Methods: from January 2005 to September 2009, the effect of tympanoplasty for cholesteatoma tympanoplasty with open papillectomy was observed. 60 cases (61 ears) of cholesteatoma were analyzed. This procedure could not be used for the reconstruction of the soft wall external auditory canal by preserving the intact structure of the skin of the normal external auditory meatus, and to reconstruct the soft wall external auditory canal with the periosteum flap of the posterior ear muscle. The tympanoplasty of type 鈪，

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