山东大学耳鼻喉眼学报 ›› 2013, Vol. 27 ›› Issue (6): 31-34.doi: 10.6040/j.issn.1673-3770.0.2013.083

• 论著 • 上一篇    下一篇

骨片重建和围手术期通气治疗根治腔的效果观察

童军1，李克勇1，陈文文2，邓亚新2，蔡勋华2，单良2，杜丽君2   

  1. 1.上海交通大学附属第一人民医院耳鼻咽喉头颈外科， 上海 200080;
    2.上海交通大学附属第一人民医院分院耳鼻咽喉科， 上海 200081
  • 收稿日期:2013-03-19 发布日期:2013-12-16
  • 通讯作者: 陈文文。Email:chewnww50@hotmail.com
  • 作者简介:童军。 Email:13816110940@163.com
  • 基金资助:

    上海市卫生局科研基金项目(2009-227); 上海市虹口区卫生局科研基金项目(2009-01-01)

Reconstruction of ear canal wall with periosteo-bone graft and postoperative mastoid cavity inflation for huge radical cavity after mastoidectomy

TONG Jun1, LI Ke-yong1， CHEN Wen-wen2， DENG Ya-xin2， CAI Xun-hua2， SHAN Liang2， DU Li-jun2   

  1. 1. Department of Otolaryngology ＆ Head and Neck Surgery, Shanghai First People′s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200080, China; 2. Department of Otolaryngology， Branch of Shanghai First People′s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200081, China
  • Received:2013-03-19 Published:2013-12-16

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摘要：

目的    探讨利用自体带骨膜的骨皮质片，修复根治后遗留的巨大腔并作听骨重建，及术后使用乳突腔充气的治疗效果。方法    回顾性分析40例手术病历资料 (再次手术3例,共43例次),均有胆脂瘤根治手术根治腔和感染流脓。术前平均气导（68.27±14.13）dBHL（AC，取0.5K,1K,2K均数，下同），平均气骨导差（GAP）（47.02±12.72）dBHL。按照手术方法，分两组：骨片组，前20耳带骨膜骨片修复根治腔和听骨重建；充气组，另23耳（其中3耳是骨片组再手术）在前述基础上引出2mm硅胶管,在术后围手术期中加用中耳充气。随访6～60个月，平均（16.46±8.36)个月，平均气骨导差（GAP）＜20dB为成功。统计分析用U检验。结果    耳道情况：40例全部耳道呈现光滑的外观。8例有随访的CT片复查，呈现上鼓室和/或乳突腔再气化；听力结果：27例（62%）为成功， 16例为显效（37%）。骨片组3例术后听力不佳，再次手术中发现均有中上鼓室间粘连，分解后使用充气法，2例获成功。结论    带骨膜骨片有助于形成正常光滑的耳道，中耳充气有利于上鼓室再气化和听力恢复。

关键词: 胆脂瘤, 中耳炎, 根治腔, 粘连, 听骨链重建

Abstract:

Objective    To investigate the effectiveness of defect repair of ear canal with autologous periosteo-bone graft and postoperative mastoid cavity inflation. Methods    Clincal data of 43 cases (40 patients) were reviewed. All patients underwent radical mastoidectomy before. The mean pre-operative air conduction (AC) was 68.27±14.13 dBHL, and the mean GAP was 47.02 ± 12.72 dBHL. These cases were further divided into two groups: a) 20 cases received ear ossicle remodeling surgery and the radical mastoid cavity was repaired by periosteo-bone graft; b) The other 23 cases（among them, 3 cases from the former group were re-operated ）received additional postoperative mastoid cavity inflation twice per day. Follow-up lasted 9-60 months (mean 16.46±8.36 months). Result s    All ear canals recovered with smooth appearance .In eight cases, postoperative CT scans showed re-gasification of attic and/or mastoid cavity. Compared with the preoperative, postoperative mean AC and GAP were 47.02±12.72 and 23.04±15.30 dBHL, respectively (both P<0.01). The effective rate was 62%(27 cases) and mild effective rate was 37%. In the 3 cases reoperated, poor postoperative hearing  were noted and the adhesion located between the mesotympanum and attic. After the revising surgery, 2 cases gained satisfying GAP. Conclusion    Bone graft containing periosteum can be used to reconstruct the ear canal. Auxiliary inflation of middle ear can promote the attic and/or mastoid cavity re-gasification and hearing recovery.

Key words: Otitis media, Cholestoma； Radical cavity, Ossicle reconstruction, Adhesion

中图分类号: 

  • R764.2
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