改良耳内切口在开放式乳突切除术中的应用

目的探讨改良耳内切口用于开放式乳突切除术的疗效。方法 选择40耳胆脂瘤型中耳炎患者行开放式乳突切除术，改良耳内切口第一切口从外耳道上壁“12点”处，弧形向后切开耳甲的内1/2至外耳道口外下方；第二切口与传统耳内切口相同。乳突切除术完成后，修剪耳甲-外耳道皮瓣并覆盖乳突腔，修剪与耳廓相连的耳甲软骨使之不暴露于外表。同期选择40耳患者行传统耳内切口术式及40耳患者行耳后切口术式分别作为对照。结果经6-36个月随访，与传统耳内切口相比，改良耳内切口术后干耳率明显提高（χ^2=6.49，P〈0.05）；出血量和切口耗时无明显差异（t=1.95，P〉0.05；t=2.7，P〉0.05）。与耳后切口相比，改良耳内切口术中出血量明显减少、切口耗时明显缩短（t=-9.08，P〈0.01；t=-10.14，P〈0.01），干耳率与耳后切口相同（100%）。结论改良耳内切口具有出血少、省时、易于行耳甲成形术等优点，值得临床推广。

Application of modified endaural incision to mastoidectomy with canal-wall down

ObjectiveTo explore the effect of modified endaural incision in mastoidectomy with canal wall down.MethodsCholesteatoma in 40 ears was surgically treated via mastoidectomy with canal wall down. The first incision of the modified endaural incision began at “12 o’clock” on the superior meatal wall, then down to about middle region of conchal cavity with an arc like curve, and finally to the outer inferior part of the meatal wall. The second incision was same as the traditional one. After mastoidectomy, the conchal meatal flap was trimmed for covering the surgical cavity. The conchal cartilage connecting with auricle was trimmed and not explored outside. As control, another 40 ears with cholesteatoma were given mastoidectomy with traditional endaural incision and 40 ears with postauricular incision.ResultsAfter 6-36 months follow up, the rate of dry cavity in ears with the modified endaural incision was higher than that with traditional one（χ^2=6.49,P〈0.05）. The differences of bleeding volume and operation time between the two groups were statistically insignificant （t=1.95,P〉0.05; t=2.7,P〉0.05）. In ears with the modified endaural incision, the bleeding volume was less and operation time was shorter than those with postauricular incision respectively （t=-9.08, P〈0.01; t=-10.14, P〈0.01）, while the rates of dry cavity in two groups were the same （100%）.ConclusionsWith advantages of less bleeding, short operation time and ease to perform conchiplasty, the modified endaural incision is worth popularizing application in clinic.