山东大学耳鼻喉眼学报 ›› 2014, Vol. 28 ›› Issue (5): 18-22.doi: 10.6040/j.issn.1673-3770.0.2014.177

• 论著 • 上一篇    下一篇

耳后多种自体中胚层软组织及皮质骨粉填充乳突修复耳道后壁在开放式手术中的临床应用

陈雪生1, 王威1, 陶静1, 尹安平2   

  1. 1. 启东市人民医院耳鼻喉科, 江苏 启东 226200;
    2. 启东市人民医院医学影像科, 江苏 启东 226200
  • 收稿日期:2014-05-27 发布日期:2014-10-16
  • 作者简介:陈雪生。E-mail：chxsh502@163.com
  • 基金资助:
    南通市医学重点人才培养基金资助项目[通卫科教[2012]9号]

Application of mastoid-cavity obliteration and ear canal posterior-wall renovation with mesodermal-tissue graft of postauricular region and mastoid cortex-bone pate in canal wall-down tympanoplasty

CHEN Xue-sheng1, WANG Wei1, TAO Jing1, YIN An-ping2   

  1. 1. Department of Otolaryngology, Qidong People's Hospital, Qidong 226200, Jiangsu, China;
    2. Department of medical imaging, Qidong People's Hospital, Qidong 226200, Jiangsu, China
  • Received:2014-05-27 Published:2014-10-16

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摘要： 目的 探讨在开放式鼓室成形术治疗慢性化脓性中耳炎和胆脂瘤型中耳炎中，采用耳后多种自体中胚层软组织和乳突皮质骨粉填充乳突术腔、修复耳道后壁以恢复耳道生理状态的临床应用。方法 慢性化脓性中耳炎和胆脂瘤型中耳炎患者21例，借助于原有开放式鼓室成形术的手术基础，设计采用耳后多种自体中胚层软组织及乳突皮质骨粉，填充乳突术腔、修复外耳道后壁，以恢复耳道生理状态。结果 术后随访6个月以上，除1例愈合后虽获干耳但仍遗留鼓膜小穿孔外，其余病例鼓膜均愈合，新外耳道较原耳道略宽敞，无明显分泌物积聚，无胆脂瘤复发，耳道干燥，后壁光滑，后内上角未形成钝角鼓膜，干耳率100%，鼓膜愈合率95.2%。结论 在开放式鼓室成形术手术基础上，采用耳后多种中胚层组织和自体骨粉填充乳突术腔修复外耳道后壁，取材方便、修复方式简便，术后修复组织无液化坏死，愈合良好。远期随访观察，术后耳道后壁形态稳定，上皮化良好，皮肤色泽正常，耳道管腔略大且更趋近于术前正常生理状态，对恢复耳道生理结构和功能具有积极意义。

关键词: 鼓室成形术, 中胚层组织, 外耳道, 自体骨粉, 外科修复

Abstract: Objective To explore the clinical method to obliterate mastoid-cavity being and renovate ear canal posterior-wall by using various mesodermal-tissue grafts of postauricular region and mastoid cortex-bone pate in canal wall-down tympanoplasty (CWdT) to treat chronic suppurative otitis media or cholesteatoma otitis media. Methods From January 2011 to December 2013, 21 cases of patients with the two types of otitis media mentioned above were subjected to the procedure. Results After more than 6 months of follow-up, except for one case who succeeded in dry ear with small eardrum perforation, all the other cases presented a dry ear, with slightly big canal and no secretion or recurrence of cholesteatoma. The posterior-walls of the canal were smooth without perforation on eardrum, and the obtuse angle was not formed between the inner upper of posterior-wall and the new eardrum. The rate of dry ear was 100%, and the rate of eardrum healed was 95.2%. Conclusion Self postauricular mesodermal-tissue graft and mastoid cortex-bone pate are simple methods to obliterate mastoid cavity and renovate posterior-wall of ear canal. After the procedure, the repairing tissue heals well with no liquefaction or necrosis. Long-term follow up confirms that the canal is slightly bigger and stable. Physiological states, such as shape, epithelization and skin color of the posterior-wall of the ear canal are satisfying.

Key words: Mesodermal tissue, Ear canal, Canal wall-down tympanoplasty, Surgical renovation, Bone pate

中图分类号: 

  • R764.9
[1] 郑军,赵燕玲,赵啸天,等.软组织修复耳道后壁鼓室成形术的临床分析[J].北京医学,2006,28(11):662-664. ZHENG Jun, ZHAO Yanling, ZHAO Xiaotian, et al. Softwall up with canal wall down procedures in tympanomastoidectomy [J]. Beijing Medical Journal, 2006, 28(11):662-664.
[2] 詹善强,汤杰,孔凡俐,等.自体乳突皮质骨粉在开放式鼓室成形术中的应用[J].江西医学院学报,2006,46(4):129-131. ZHAN Shanqiang, TANG Jie, KONG Fanli, et al. The application of bone pate from self mastoid cortex in the surgery of mastoidectomy with tympanoplasty[J]. Acta Academiae Medicinae Jiangxi, 2006, 46(4):129-131.
[3] 孔维佳,汪吉宝,张甦琳.扩大耳后带蒂肌骨膜瓣-耳道皮瓣复合瓣开放式改良乳突根治术腔堵塞术[J].中华耳鼻咽喉-头颈外科杂志,2007,42(7):487-490. KONG Weijia, WANG Jibao, ZHANG Sulin. Combined flap of postauricular musculo-periosteal and ear canal skin flap with bone pate for mastoid obliteration and canal wall mastoidectomy [J]. Chinese Journal of Otorhinolaryngology-Head and Neck Surgery,2007,42(7):487-490.
[4] 王正敏.耳显微外科[M].上海:上海科学技术文献出版社,1989:47-54.
[5] 黄选兆,汪吉宝,孔维佳.实用耳鼻咽喉头颈外科学[M].2版.北京:人民卫生出版社,2008:900-904.
[6] 李正贤,李学佩,宋为明.开放式鼓室成形术治疗胆脂瘤型中耳炎疗效观察[J].中华耳科学杂志,2004,2(4):254-256. LI Zhengxian, LI Xuepei, SONG Weiming. Cholesteatoma surgery: open tympanoplasty [J]. Chinese Journal of Otology, 2004, 2(4):254-256.
[7] 陈雪生,尹安平,顾瑛,等.慢性化脓性中耳炎手术疗效及相关因素探讨[J].河北医药,2006,28(11):1038-1039. CHEN Xuesheng, YIN Anping, GU Ying, et al. The effects of canal wall down tympanoplasty and mastoidectomy on chronic suppurative otitis media [J]. Hebei Medical Journal, 2006, 28(11):1038-1039.
[8] 吴志勇,刘平,李东生,等.乳突根治＋开放式鼓室成形术治疗胆脂瘤中耳炎的体会[J].听力学及言语疾病杂志,2011,19(2): 178-179. WU Zhiyong, LIU Ping, LI Dongsheng, et al. Experience of mastoidectomy with open tympanoplasty on cholesteatoma otitis media[J]. Journal of Audiology and Speech Pathology, 2011, 19(2):178-179.
[9] 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. A review of 204(192cases) consecutive free flap transfers for head and neck reconstruction [J]. Chinese Journal of plastic surgery, 2002, 18(2):104-106.
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