两瓣法外耳道成形加骨粉充填在开放式乳突手术中的应用

目的探讨开放式乳突手术中采用两瓣法行外耳道成形、自体骨粉充填行外耳道后壁重建的应用价值。方法采用回顾性横断面研究方法。纳入蚌埠医学院第一附属医院耳鼻咽喉头颈外科2015年6月—2018年1月收治的慢性化脓性中耳炎患者136例136耳临床资料,其中男66例66耳、女70例70耳;年龄5~77岁,中位年龄43.5岁;左耳78例,右耳58例。行乳突根治术29耳,Bondy手术5耳,开放式乳突切开+鼓室成形术79耳,完桥式乳突切开+鼓室成形术23耳;均以两瓣法外耳道成形、自体骨粉充填乳突腔外耳道后壁重建。术后观察患者干耳时间,复发情况,有无面瘫眩晕、皮瓣坏死、软骨感染等并发症,重建的外耳道形态。结果术后随访时间9~39个月。开放手术后干耳率98.5%(134/136),干耳时间为1~5.6个月,平均为1.8个月;另外2耳分别于开放手术后2、5个月给予二次修正手术后获得干耳。术后无一例出现面瘫、眩晕、外耳道瓣或耳廓软骨感染坏死等明显并发症。随访期间见患者外耳道口无狭窄,形态圆滑,上下两皮瓣成活良好,开放的外耳道和乳突腔大小介于正常外耳道与传统的乳突轮廓化的术腔之间。结论本研究首次报道,在慢性化脓性中耳炎的开放式乳突手术中,采用两瓣法外耳道成形、自体骨粉充填乳突腔行外耳道后壁重建,安全有效,值得临床推广。

Application of two-flap technique and bone autograft mastoid obliteration for external auditory canal plasty among canal wall down mastoidectomy

Objective To investigate the value of two-flap technique and bone autograft mastoid obliteration for external auditory canal plasty among canal wall down mastoidectomy. Methods The retrospective cross-sectional study was conducted. One hundred and thirty-six ears of 136 patients with chronic suppurative otitis media were enrolled in the Department of Otolaryngology Head and Neck Surgery of the First Affiliated Hospital of Bengbu Medical College from June 2015 to January 2018, including 66 males and 70 females, aged from 5 to 77 years, with a median age of 43.5 years, 78 left ears and 58 right ears. Canal wall down mastoidectomy was performed in all cases, radical mastoidectomy in 29 ears, modified mastoidectomy (Bondy technique) in 5 ears, canal wall down mastoidectomy plus tympanoplasty in 79 ears, intact-bridge mastoidectomy plus tympanoplasty in 23 ears. Two-flap technique for external auditory canal plasty and bone autograft mastoid obliteration for reconstruct of the posterior wall of external auditory canal was used in all cases. Results All patients were followed up from 9 to 39 months. Drying ear rate was 98.5%(134/136), drying ear time was ranged from 1 to 5.6 months, with an average of 1.8 months. No facial paralysis and vertigo were found after operation, and no complications such as infection of external ear canal or auricular cartilage were found. The opening of the external auditory canal and the mastoid cavity were between the normal external auditory canal and the traditional cavity of skeletonization of mastoid. Conclusions For the first time, we reports the two-flap technique for external auditory canal plasty and bone autograft mastoid obliteration for reconstruct of the posterior wall of external auditory canal among canal wall down mastoidectomy is an important, safe and effective procedure for treatment of chronic suppurative otitis media. It is worth application and dissemination.