耳后多种自体中胚层软组织及皮质骨粉填充乳突修复耳道后壁在开放式手术中的临床应用

目的：探讨在开放式鼓室成形术治疗慢性化脓性中耳炎和胆脂瘤型中耳炎中，采用耳后多种自体中胚层软组织和乳突皮质骨粉填充乳突术腔、修复耳道后壁以恢复耳道生理状态的临床应用。方法慢性化脓性中耳炎和胆脂瘤型中耳炎患者21例，借助于原有开放式鼓室成形术的手术基础，设计采用耳后多种自体中胚层软组织及乳突皮质骨粉，填充乳突术腔、修复外耳道后壁，以恢复耳道生理状态。结果术后随访6个月以上，除1例愈合后虽获干耳但仍遗留鼓膜小穿孔外，其余病例鼓膜均愈合，新外耳道较原耳道略宽敞，无明显分泌物积聚，无胆脂瘤复发，耳道干燥，后壁光滑，后内上角未形成钝角鼓膜，干耳率100％，鼓膜愈合率95．2％。结论在开放式鼓室成形术手术基础上，采用耳后多种中胚层组织和自体骨粉填充乳突术腔修复外耳道后壁，取材方便、修复方式简便，术后修复组织无液化坏死，愈合良好。远期随访观察，术后耳道后壁形态稳定，上皮化良好，皮肤色泽正常，耳道管腔略大且更趋近于术前正常生理状态，对恢复耳道生理结构和功能具有积极意义。

Application of mastoid-cavity obliteration and ear canal posterior-wall renovation with mesodermal-tissue graft of postauricular region and mastoid cortex-bone pate in canal wall-down tympanoplasty

Objective To explore the clinical method to obliterate mastoid-cavity being and renovate ear canal posterior-wall by using various mesodermal-tissue grafts of postauricular region and mastoid cortexbone pate in canal wall-down tympanoplasty （CWdT）to treat chronic suppurative otitis media or cholesteatoma otitis media.Methods From January 2011 to December 2013,21 cases of patients with the two types of otitis media mentioned above were subjected to the procedure.Results After more than 6 months of follow-up,except for one case who succeeded in dry ear with small eardrum perforation,all the other cases presented a dry ear,with slightly big canal and no secretion or recurrence of chol-esteatoma.The posterior-walls of the canal were smooth without perforation on eardrum,and the obtuse angle was not formed between the inner upper of posterior-wall and the new eardrum.The rate of dry ear was 100%,and the rate of eardrum healed was 95 .2%.Conclusion Self postauricular mesodermal-tissue graft and mastoid cortexbone pate are simple methods to obliterate mastoid cavity and renovate posterior-wall of ear canal.After the procedure,the repairing tissue heals well with no liquefaction or necrosis.Long-term follow up confirms that the canal is slightly bigger and stable. Physiological states,such as shape,epithelization and skin color of the posterior-wall of the ear canal are satisfying.