耳内镜下耳屏软骨-软骨膜重建上鼓室外侧壁的临床应用

Application of Tragal Cartilage and Perichonrium in Reconstruction of the Lateral Attic Wall with Endoscopic Ear Surgery

王涛;瞿申红;唐凤珠;唐杰;桂志;莫锦营;李春玲;

1:广西壮族自治区人民医院耳鼻咽喉头颈外科

摘要
目的探讨耳内镜下耳屏软骨-软骨膜重建外耳道后壁或上鼓室外侧壁的临床应用及术后效果。方法回顾性分析2015年8月~2019年8月期间住院手术的52例(52耳)外耳道及中耳胆脂瘤患者的临床资料,病变均累及上鼓室及鼓窦,其中45例为中耳胆脂瘤,7例为外耳道胆脂瘤,均在耳内镜下行上鼓室开放术同期行鼓室成形,术中用耳屏软骨-软骨膜重建上鼓室外侧壁或外耳道后壁,分析手术技术要点、观察术后干耳时间、鼓膜愈合、上鼓室外侧壁塌陷及听力疗效等相关情况。结果 52例(52耳)术后平均随访时间26.3±7.2个月,术后平均干耳时间27.5±8.8天;鼓膜完全愈合47耳(90.4%,47/52),其中鼓膜完全愈合且形态正常41耳(78.8%,41/52),鼓膜愈合但内陷6耳(11.5%,6/52);复发5耳(9.6%,5/52),其中紧张部内陷穿孔1耳(1/52,1.9%),松弛部内陷伴穿孔4耳(4/52,7.7%);无一例面瘫和外耳道狭窄。术后12个月,0.5、1、2、4 kHz平均气导听阈(32.1±5.8 dB HL)较术前(53.2±10.4 dB HL)明显降低(P<0.001),ABG(15.6±7.6 dB)值较术前(41.5±7.4 dB)明显降低(P<0.001)。结论对于累及上鼓室的外耳道或中耳胆脂瘤,可经耳内镜行上鼓室开放术清除病变,用耳屏软骨-软骨膜重建上鼓室外侧壁或外耳道后壁,依靠软骨的支撑,可维持鼓室、鼓窦及乳突腔含气腔,减少鼓膜松弛部内陷的发生,保持上鼓室外侧壁的基本形态。
关键词
耳屏软骨;软骨膜;上鼓室外侧壁;胆脂瘤
基金项目(Foundation):
作者
王涛;瞿申红;唐凤珠;唐杰;桂志;莫锦营;李春玲;
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