保留外耳道后壁上鼓室切开软骨重建术治疗中耳胆脂瘤

Epitympanoplasty with Cartilage Obliteration in the Canal Wall Up Technique to the Middle Ear Cholesteatoma

赵丹珩;刘阳;孙建军;林勇生;

1:海军总医院全军耳鼻喉科中心

摘要

目的探讨在保持外耳道后壁完整的情况下,切除上鼓室外侧壁并软骨封闭治疗中耳胆脂瘤的疗效。方法 2009年11月-2012年7月对123例(123耳)中耳胆脂瘤患者行保留外耳道后壁的乳突切开、上鼓室盾板切除及面神经隐窝向上鼓室开放,清除病变后行上鼓室软骨封闭及乳突腔填塞术,术后随访6-38个月,观察胆脂瘤复发、上鼓室回缩袋形成情况及听力提高水平,分析其疗效。结果 123例中,2例中耳腔胆脂瘤复发,6例术后耳后切口感染,3例鼓膜边缘穿孔延迟愈合,2例人工听骨脱出,4例术后耳道后壁肿胀或皮肤缺损,其余病例术后换药2-3次后鼓膜、外耳道形态恢复,痊愈时间1个月。听力资料完整的83例(67.5%,83/123)中,0.5、1、2kHz气骨导差术前平均32.2±11.25dB,术后平均20.69±12.41dB,手术前后气骨导差缩小11.59±10.1dB(P<0.001)。结论乳突切开同时保留外耳道后壁使耳道形态得以保留,术后恢复时间短;切除上鼓室外侧壁能够更充分暴露病变,病灶清除彻底;上鼓室外侧壁软骨封闭重建可有效防止回缩袋的形成,避免胆脂瘤复发。

关键词

中耳胆脂瘤;上鼓室重建;软骨;封闭

基金项目(Foundation):

作者

赵丹珩;刘阳;孙建军;林勇生;

参考文献

1 Palva T.Surgical treatment of chronic middle ear disease.II.Canal wall up and canal wall down procedures[J].Acta Oto-laryngol,1987,104:487.

2 Paparella MM,Froymovich O.Surgical advances in treating o-titis media[J].Ann Otol Rhinol Laryngol,1994,163(Suppl):49.

3 Alleva M,Paparella MM,Morris MS,et al.The flexible/in-tact-bridge tympanomastoidectomy technique[J].Otolaryn-gol Clin North Am,1989,22:41.

4 刘阳,孙建军,林勇生.保留骨桥的乳突鼓室成形术(IBM)远期疗效与相关技术再探讨[J].中华耳科学杂志,2007,5:148.

5 孙建军,刘阳,汤勇,等.胆脂瘤中耳炎的外科治疗策略[J].中华耳鼻咽喉头颈外科杂志,2007,42:483.

6 Kang KM,Ahn JK,Gu JW,et al.Epitympanoplasty withmastoid obliteration technique:A long-term study of results[J].Otolaryngology-Head and Neck Surgery,2009,140:687.

7 刘阳,孙建军,赵丹珩.乳突鼓室成形伴上鼓室切开重建技术治疗胆脂瘤性中耳炎[J].中华耳科学杂志,2010,8:254.

8 中华医学会耳鼻咽喉头颈外科学分会耳科学组,中华耳鼻咽喉头颈外科杂志编辑委员会耳科组.中耳炎的临床分类和手术分型指南(2012)[J].中华耳鼻咽喉头颈外科杂志,2013,48:5.

9 American Academy of Otolaryngology-Head and Neck Sur-gery foundation.Committee on hearing and equilibrium ofguidelines for the evaluation of results of treatment of conduc-tive hearing loss[J].Otolaryngol Head Neck Surg,1995,113:186 .

10 Pennings RJ,Cremers CW.Postauricular approach atticoto-my:a modified closed technique with reconstruction of thescutum with cymbal cartilage[J].Ann Otol Rhinol Laryngol,2009,118:199.

11 Weber PC,Gantz BJ.Cartilage reconstruction of the scutumdefects in canal wall up mastoidectomies[J].Am J Otolaryn-gol,1998,19:178.

12 Hinohira Y,Yanagihara N,Gyo K.Surgical treatment of re-traction pocket with bone pate:scutum plasty for cholesteato-ma[J].Otolaryngol Head Neck Surg,2005,133:625.

13 Bacciu A,Pasanisi E,Vincenti V,et al.Reconstruction ofouter attic wall defects using bone paté:Long-term clinicaland histological evaluation[J].Eur Arch Otorhinolaryngol,2006,263:983.

14 SadéJ.Treatment of cholesteatoma[J].Am J Otol,1987,8:524 .

15 迟放鲁,王正敏,吴琍雯.上鼓室封闭和外侧壁重建技术在鼓室成形术中的应用[J].中华医学杂志,2002,82:1 617.

16 刘阳,孙建军,林勇生,等.中耳术后感染对羟基磷灰石人工听骨的影响[J].中华耳科学杂志,2010,8:268.

17 Yung M.Cartilage tympanoplasty:literature review[J].JLaryngol Otol,2008,122:663.

本文信息

PDF(191K)

本文关键词相关文章

中耳胆脂瘤上鼓室重建软骨封闭

本文作者相关文章

赵丹珩刘阳孙建军林勇生