软壁夹层法在开放性乳突根治伴鼓室成形术中的应用

目的　探讨开放性乳突根治术一期外耳道重建及鼓室成型术的方法。方法　乳突根治术时 ,收集皮质骨粉、取颞肌筋膜备用 ,制作蒂在前方的乳突肌骨膜瓣 ,乳突根治术后用骨粉填塞乳突腔 ,软壁夹层法一期行外耳道后壁成形及中耳重建术。结果　术后随访 3个月以上者 47例 ,全部病例重建外耳道接近正常生理结构 ;除 1例术后 3个月仍未干耳外 ,46例平均干耳时间 2 2天 ;听力提高 >15dB 3 6耳 (76.6% ) ,<15dB 8耳 (17.0 % ) ,无改善 3耳 (6.4% )。结论　用乳突皮质骨粉充填乳突腔、乳突肌骨膜瓣软壁夹层法行一期外耳道及中耳重建术 ,缩短了术后干耳时间 ,是解决听力重建及乳突根治术后“根治腔病”较为理想的术式。

Application of soft-wall and inlay technique in mastoidectomy with tympanoplasty

Objective To explore the method of reconstruction of the wall of external auditory and voice conduction structure after radical mostoidectomy.Methods Mastoid obliteration with mastoid os integumentale dust was done after radical mostoidectomy. The posterior wall of external auditory was reconstructed with the periost postauricular composite flap (soft wall technique), and one-stage tympanoplasty was done with inlay technique.Results All constructed posterior canal wall were near normal structure followed up 3 months after operation. The average drying ear time was 22 days postoperatively in 46 ears. The hearing improvement over 15 dB were 36 ears (76.6%) and under 15 dB were 8 ears (17.0%). The hearing was not improved in 3 ears.Conclusion The soft wall construction of external auditory and tympanoplasty with inlay technique after radical mastoidectomy in one stage is a ideal surgery to construct hearing structure and avoid infection of middle cavity after radical mostoidectomy.