中耳乳突手术自体骨粉重建外耳道的观察

目的观察中耳乳突手术中应用自体乳突皮质骨粉重建外耳道的疗效。方法 13例（13耳）中耳炎患者,其中胆脂瘤中耳炎8例,慢性化脓性中耳炎5例,行开放式乳突病变切除＋鼓室成形术9例,行改良乳突根治术4例,均应用自体乳突皮质骨粉重建外耳道。观察术后外耳道的形态和功能及听力变化。结果本组平均干耳时间为术后（32.0±6.5）d。随访4～16个月,术后外耳道形态基本正常,无须经常清理结痂。4例改良乳突根治术后听力无变化。9例鼓室成形术后平均气骨导差为（21.3±14.7）dB听力级（HL）,术前平均气骨导差（36.3±11.9）dBHL,手术前后比较差异有统计学意义（P〈0.05）。结论在中耳乳突手术中应用自体乳突皮质骨粉重建外耳道,取材方便,效果满意。

Clinical observation of external canal reconstruction with autogenous bone pate in the micro-otosurgery

Objective To observe the therapeutic effect of external canal reconstruction with autogenous bone pate from the mastoid cortex in the micro-otosurgery.Methods Thirteen patients（13 ears） with chronic otitis media comprising cholesteatoma（8 cases） and chronic suppurative otitis media（5 cases） underwent reconstruction of external canal with autogenous bone pate from the mastoid cortex.Of the 13 cases,9 were treated with canal wall down mastoidectomy plus tympanoplasty（CWD）,and 4 cases were treated with modified radical mastoidectomy（MRM）.The autogenous bone pate was used to obliterate mastoid cavity and reconstruct the external canal in all the 13 cases.The postoperative modality and function of the external auditory canal and the postoperative hearings were observed.Results The mean dry ear time was（32±6.5） days after surgery.The postoperative modality of external auditory canal was normal on the whole,and there was no crust which need to be cleaned usually.All patients were followed up for 4-16 months.The postoperative hearings of 4 cases underwent MRM remained unchanged.The postoperative average air-bone gap of 9 cases underwent CWD was lower than that of the preoperative ones〔（21.3±14.7） dB HL vs（36.3±11.9） dB HL,P〈0.05〕.Conclusions External canal reconstruction with autogenous bone pate from the mastoid cortex in the micro-otosurgery is convenient for drawing materials and its therapeutic effect is satisfactory.