上鼓室封闭和外侧壁重建技术在鼓室成形术中的应用

目的 观察上鼓室封闭和外侧壁重建技术在防止鼓室成形术后胆脂瘤复发或听骨链运动受限中的效果。方法 （1）上鼓室成形技术;对病灶清除后听骨链完好者,重建上鼓室外侧壁,采用2种材料;（1）“骨水泥”板（用凝血酶纤维蛋白元粘合剂与自体乳突皮质骨粉黏合而成）：（2）耳廓软骨。（2）上鼓室封闭技术;用骨粉和凝血酶纤维蛋白元黏合剂将上鼓室完全封闭。结果 150例术后观察3-5年,无继发性上鼓室严重内陷和继发性胆脂瘤,术后鼓膜再穿孔8例（5.33%)。97.5%上鼓室成形听力改善;80.8%上鼓室封闭 听骨链重建术听力改善,另21例未重建听骨链。结论 上鼓室封闭和上鼓室成型可以防止胆脂瘤复发。上鼓室外侧壁重建还可保证听骨链的正常活动空间。

Application of lateral attic wall reconstruction and sealing of attic cell in tympanoplasty

Objective To observe the effects of lateral attic wall reconstruction and sealing of attic cell in prevention of recurrence of cholesteatoma and limitation of ossicular chain after tympanoplasty. Methods 150 cases of chronic tympanitis and mastoiditis were studied. Forty patients with intact ossicular chain after opening mastoidectomy underwent lateral attic wall reconstruction with autologous cartilage of auricular choncha (n=15) or "bone cement plate" made of autologous bone cortex powder adhered by glue of fibrinogen and thrombin (n=25). Eighty-nine of the 110 cases with damaged ossicular chain underwent reconstruction of ossicular chain and sealing of tympanic cavity with bone powder and glue of fibrinogen and thrombin and fascia of temporal muscle was used to restore the tympanic membrane in 21 of them. Follow-up was conducted for 3 to 5 years to observe the recovery of tympanic membrane, hearing, and whether cholesteatoma recurred. Results No recurrent cholesteatoma and serious retracted tympanic membrane were found. Eardrum reperforated in 8 cases (5.33%). The patients with lateral attic wall reconstruction obtained a significant hearing improvement (97.5%). Hearing was improved among 80.8% of the cases that underwent sealing of attic cell and ossiculoplasty. Conclusion Lateral attic wall reconstruction and sealing of attic cell prevent the recurrence of cholesteatoma. Reconstruction of lateral attic wall provides a new space for vibration of ossicular chain.