二次开放式乳突根治术的远期疗效

目的探讨慢性中耳炎首次乳突根治术后持续不干耳的原因及再次开放式乳突根治术施行乳突腔填塞、外耳道后壁重建及鼓室成形术的远期疗效。方法收集外院曾行经典开放式乳突根治术后长期不干耳患者14例(14耳),采用带血管蒂的耳后软组织瓣及颞肌瓣填塞乳突腔,取乳突骨皮质重建上鼓室及外耳道后壁,有适应证者同期行鼓室成形术。结果二次开放式乳突根治术后随访1～5年,14耳均保持干耳,外耳道形态大致正常或略扩大。结论二次开放式乳突根治术在分析首次手术失败原因的基础上加以改进,其优点为:①术后基本无乳突腔,外耳道形态近正常或略扩大,有利于保持干耳;②有适应证者均同期行鼓室成形术,有利于改善听力。乳突腔填塞、外耳道后壁重建及鼓室成形术值得推广。

Long-term effect of radical re-mastoidectomy for chronic otitis media

Objective To discuss the causes of sustained quit ear after radical mastoidectomy,and the long-term results of radical re-mastoidectomy including tamping of the radical mastoid cavity,reconstruction of the external auditory canal wall,and tympanoplasty.Methods 14 patients(14 ears) who were undergone the radical mastoidectomy with postoperative sustained quit ear or repeated infection were given radical re-mastoidectomy.Meanwhile,the radical mastoid cavity was tamped with pedicle soft tissue flap and/or temporal muscle flap,and the external auditory canal and superior tympanum were reconstructed with mastoid cortical bone.Tympanoplasty was applied to those with indications.Results After followed up for one to five years postoperatively,all 14 ears remained dry,and the shape of external auditory canal kept normal or slightly expanded.Conclusion With advantages as followings: ① maintenance of a dry ear due to tamping of the radical mastoid cavity and normal or slightly expanded external auditory canal,② improvement of hearing owing to concomitant tympanoplasty,the radical re-mastoidectomy including tamping of the radical mastoid cavity,reconstruction of the external auditory canal wall and tympanoplasty is worthy to be popularized.