带蒂颞肌瓣填塞在二次乳突根治术中的应用

doi:10.6040/j.issn.1673-3770.0.2015.183

摘要/Abstract

摘要： 目的探讨耳后带蒂筋膜-颞肌瓣在二次开放式乳突根治术中乳突腔填塞的临床应用.方法对开放式乳突根治术后长期渗液不干耳患者20例(20耳),行二次开放式乳突根治术.行开放式乳突根治术(RM)10例,行开放式乳突根治术伴乳突填塞术(CWDM)10例.CWDM均采用耳后带蒂筋膜-颞肌瓣乳突腔填塞.结果术后均随访2年,RM干耳时间平均(58.4±4.45)d,复诊次数平均(17.1±2.33)次,持续不干耳1例.CWDM 干耳时间平均(29.6±2.37)d,复诊次数平均(6.1±1.52)次,无不干耳及术后复发.两组比较,CWDM干耳时间短、复诊次数少(P<0.001).结论 CWDM干耳时间、复诊次数、术后复发等指标均优于RM,采用带蒂筋膜-颞肌瓣乳突腔填塞效果良好.

关键词: 乳突根治, 筋膜-颞肌瓣, 二次手术, 填塞

Abstract: Objective To explore the clinical application of mastoid cavity packing by retroauricular pedicle fascia-temporalis muscle flap in secondary open radical mastoidectomy. Methods A total of 20 patients (20 ears) who had undergone open radical mastoidectomy received secondary open radical mastoidectomy due to long-time wet seepage of their ears. Of them, 10 received open radical mastoidectomy (RM) and 10 received open radical mastoidectomy with mastoid packing operation (CWDM). All CWDM operations adopted retroauricular pedicle fascia-temporalis muscle flap mastoid cavity packing. Results All cases were followed up for 2 years. The average time of ear drying was (58.4±4.45)d and (29.6±2.37)d in RM group and CWDM group, respectively. The average return visit frequency was (17.1±2.33) and (6.1±1.52) times in RM group and CWDM group, respectively. One case in the RM group had wet ear continuously. There was no wet ear and relapsing after operation in the CWDM group. CWDM group had a shorter ear drying time and lower return visit frequency than the RM group (P<0.001). Conclusion CWDM is superior to RM in ear drying time, return visit frequency and relapsing after operation and other indicators. The mastoid cavity packing by retroauricular pedicle fascia-temporalis muscle flap has a good effect.

Key words: Radical mastoidectomy, Secondary operation, Packing, Fascia-temporalis muscle flap

中图分类号:

R764.9

李东方. 带蒂颞肌瓣填塞在二次乳突根治术中的应用[J]. 山东大学耳鼻喉眼学报, 2015, 29(6): 13-16.

LI Dongfang. Application of pedicle temporal muscle flap in the treatment of secondary radical mastectomy[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2015, 29(6): 13-16.

参考文献

[1] 孙建军, 刘阳. 中耳临床分型和手术分型指南(2012)解读[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(1):6-10 SUN Jianjun, LIU Yang. Interpretation of clinical classification and surgical typing of middle ear in middle ear (2012)[J]. Chin J Otorhinolaryngology Head Neck Surgery, 2013, 48(1):6-10.
[2] Gantz B J, Wilkinson E P, Hansen M R. Canal wall reconstruction tympanomastoidectomy with mastoid obliteration[J]. Laryngoscope, 2005, 115(10) :1734-1740.
[3] 黄选兆, 汪吉宝. 实用耳鼻咽喉头颈外科学[M]. 2版. 北京: 人民卫生出版社, 2010: 903.
[4] 刘阳, 孙建军, 林永生, 等. 中耳乳突外科中自体骨粉乳突填充与外耳道成形[J]. 中国耳鼻咽喉头颈外科杂志, 2006, 13(7):475-476. LIU Yang, SUN Jianjun, LIN Yongsheng, et al. The middle ear and mastoid surgery autologous bone powder mastoid filled with the external auditory canal forming[J]. Chin Otolaryngol Otolaryngol Head Neck Surg, 2006, 13(7):475-476.
[5] 刘阳, 孙建军. 中耳胆脂瘤上鼓室的外科处理[J]. 临床耳鼻咽喉头颈外科杂志, 2014, 28(21):1633-1635. LIU Yang, SUN Jianjun. Surgical treatment of middle ear cholesteatoma tympani[J]. Clin J Otorhinolaryngol Head Neck Surg, 2014, 28(21):1633-1635.
[6] Syms M J, Luxford W M. Management of cholesteatoma: status of the canal wall[J]. Laryngoscope, 2003, 113(3):443-448.
[7] Blevins N H. Transfacial recess ossicular reconstruction: technique and early results[J]. Otol Neurotol, 2004, 25(3):236-241.
[8] 毛驰, 俞光岩, 彭歆, 等. 192例头颈部游离组织瓣移植的临床分析[J]. 中华整形外科杂志, 2002, 18(2):104-106. MAO Chi, YU Guangyan, PENG Xin, et al. Clinical analysis of free tissue flap transplantation in head and neck of 192 cases[J]. Chin J Plastic Surgery, 2002, 18(2):104-106.
[9] 晋培红, 许枫, 张如鸿, 等. 耳后动脉在乳突区分支的解剖学研究[J]. 组织工程与重建外科杂志, 2008, 4(4):211-212. JIN Peihong, XU Feng, ZHANG Ruhong, et al. Anatomic study of the posterior auricular artery in the papillary region of the papillary region[J]. Tiss Eng Recons Surg J, 2008, 4(4):211-212.
[10] Mehta R P, Harris J P. Mastoid obliteration[J] . Otolaryngol Clin North Am, 2006, 39(6):1129-1142.
[11] Lee W S, Choi J Y, Song M H, et al. Mastoid and epitympanicobliteration in canal wall up mastoidectomy for prevention of retraction pocket[J]. Otol Neurotol, 2005, 26(6):1107-1111.
[12] 王克非. 根治术后的乳突重建术[J]. 国外医学耳鼻咽喉科学分册, 1993, 17(1):61. WANG Kefei. Radical mastoidectomy reconstruction surgery[J]. For Med Sci Otolaryngol, 1993, 17(1):61.
[13] 黄选兆, 汪吉宝. 实用耳鼻咽喉头颈外科学[M]. 2版. 北京: 人民卫生出版社, 2010: 903-904.
[14] 李东方, 杨世国, 丁长青, 等. 中耳胆脂瘤一例[J]. 中华耳鼻咽喉头颈外科杂志, 2007, 42(6):427. LI Dongfang, YANG Shiguo, DING Changqing, et al. One case of cholesteatoma of the middle ear[J]. Chin J Otorhinolaryngol Head Neck Surgery, 2007, 42(6):427.
[15] 李东方, 李月英, 李庆华, 等. 耳后带蒂颞肌瓣乳突腔填塞治疗乳突根治术后迷路瘘管[J]. 中国眼耳鼻喉科杂志, 2013, 13(5):320-321. LI Dongfang, LI Yueying, LI Qinghua, et al. Ear belt pedicle temporal muscle flap in mastoid cavity packing in the treatment of mastoid radical resection of labyrinthine fistula[J]. Chin Ophthalmol Otorhinolaryngol, 2013, 13(5):320-321.

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