保持外耳道后壁完整的上鼓室切开软骨重建技术在中耳炎手术中的应用

目的观察在保持外耳道后壁完整的情况下，上鼓室切开软骨重建技术在中耳炎手术中的应用及疗效。方法对45例（耳）中耳胆脂瘤和13例（耳）活动期中耳炎患者，在保留外耳道后壁乳突切开、上鼓室外侧壁切除或及经砧骨窝向下开放面隐窝，清除听骨链区（包括上鼓室、中后鼓室）及鼓窦乳突区病变后，行上鼓室软骨封闭重建术，术后随访12～36个月，观察术后中耳炎胆脂瘤复发、鼓膜形态及听力提高等情况。结果58例（耳）术后重建的上鼓室外侧壁与保留的外耳道后壁相连接。本组病例中6例术后外耳道后壁肿胀或皮肤缺损，继续换药4~5次后愈合良好；3例患者出院后仍有少量流脓，鼓膜边缘穿孔，门诊局部给药后延迟愈合；3例听骨脱出、2例鼓膜再穿孔、2例24个月后原胆脂瘤复发，行开放式手术后治愈。术后6个月复查纯音听力测试，并与术前进行比较，听力均有不同程度提高，0.5、1、2 kHz气骨导差平均减10 dB，气导听阈平均提高15 dB 左右。结论在保持外耳道后壁完整的情况下，上鼓室切开软骨重建技术在中耳炎外科手术中的应用，既能够充分暴露病变，病灶清除彻底，同时又保留了外耳道的形态，可有效防止鼓膜回缩袋的形成，降低了胆脂瘤的复发，又避免了开放式手术所残留的宽大术腔。术后鼓膜形态恢复良好，从而保持或提高了患者的听力。

Application of epitympanoplasty with cartilage obliteration and canal wall up procedure in the surgical treatment of otitis media

ObjectiveTo investigate the application and therapeutic effect of epitympanoplasty with cartilage obliteration and canal wall up procedure in the surgical treatment of otitis media.Methods45 cases of middle ear cholesteatoma and 13 cases of active otitis media were included in our study. After mastoidectomy with preserved posterior canal wall, resection of the lateral wall of epitympanum, and opening of the facial recess as well as removal of the lesions in these regions, epitympanoplasty with cartilage obliteration was performed in all the patients. The patients were followed up for 12 to 36 months postoperatively for evaluation of therapeutic outcomes including recurrence of cholesteatoma, morphology of tympanic membrane and hearing improvement.ResultsThe connection between the reconstructed lateral wall of epitypanum and the preserved posterior canal wall was established in all 58 patients. Postoperative swelling or skin defect of the canal wall occurred in 6 cases and got cured with subsequent dressings for 4 to 5 times. 3 cases experienced light discharge with marginal perforation of tympanic membrane and got delayed healing by local drug therapy. Exclusion of the ossicular replacement prosthesis and secondary perforation of tympanic membrane were observed in 3 and 2 patients respectively. Recurrence of cholesteatoma was found and cured with traditional mastoidectomy in 2 patients. At 6 months after operation, all the patients presented hearing improvement in different extent including decrease of average air bone gap at 0.5, 1k and 2k Hz by 10 dB, and improvement of average air conduction hearing threshold by about 15 dB.ConclusionsFor the surgical treatment of otitis media, the epitympanoplasty with cartilage obliteration and canal wall up procedure can provide not only fully exposure and removal of the lesions but also the intact of posterior canal wall to effectively prevent the formation of retraction pocket in attic. This technique can decrease recurrence of cholesteatoma and avoid large surgical cavity in canal wall down technique. With perfect recovery of tympanic morphology, hearing preservation and improvement can be obtained.