自体软骨在听力重建手术中的应用

Application of Autogeneic Cartilage in Hearing Reconstruction Surgery

贾欢;汪照炎;黄琦;杨军;吴皓;

1:上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科

2:上海交通大学医学院耳科学研究所

摘要
目的分析自体软骨在慢性化脓性中耳炎、中耳胆脂瘤听力重建手术中的应用及疗效。方法回顾性分析165例(173耳)采用自体软骨行听力重建的中耳手术患者的临床资料,其中单纯鼓膜穿孔43例(48耳),中耳胆脂瘤61例(61耳),鼓室硬化23例(23耳),慢性化脓性中耳炎伴肉芽38例(41耳)。自体软骨材料用于修补鼓膜133例(139耳),用于人工听骨赝复物上衬垫102例(104耳),用于上鼓室、鼓窦重建31例(31耳),用于外耳道后壁重建3例(3耳)。比较患者术前、术后1年随访时0.5、1、2、4kHz的纯音平均听阈、平均气骨导差及局部修复成功率。结果鼓膜修补的133例139耳中,136耳修补成功,3耳出现移植物边缘小穿孔,一期鼓膜修补成功率97.84%(136/139);听骨链重建的102例(104耳)中,无听骨赝复物脱出病例;31例(31耳)上鼓室、鼓窦重建的患者中,局部未见内陷、移位;3例(3耳)外耳道修复的患者未见外耳道后壁塌陷。43例(48耳)单纯鼓膜修补的患者术前、术后气骨导差分别为23.8±3.1和11.6±8.7dB。61例(61耳)中耳胆脂瘤患者术前、术后气骨导差分别为39.2±24.7和19.0±12.1dB。23例(23耳)鼓室硬化的患者术前、术后气骨导差分别为31.2±12.4和19.8±11.2dB。38例(41耳)慢性化脓性中耳炎伴肉芽患者术前、术后气骨导差分别为41.6±9.9和15.3±13.4dB。结论自体软骨在听力重建手术中应用价值大,特别适合于鼓膜复杂性穿孔、复发性穿孔的修复,有利于听骨链假体的固定及上鼓室、乳突术腔及骨性外耳道缺损修复。
关键词
自体软骨;慢性化脓性中耳炎;胆脂瘤;听力重建
基金项目(Foundation):
作者
贾欢;汪照炎;黄琦;杨军;吴皓;
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