骨粉在开放式改良乳突根治术术腔处理中的应用Bone Pate for Mastoid Obliteration after Canal Wall Down Mastoidectomy
王珍;王艺贝;陈晓巍;
WANG Zhen;WANG Yi-bei;CHEN Xiao-wei;Department of Otolaryngology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;
摘要(Abstract):
目的探讨骨粉填塞用于开放式改良乳突根治术的可行性和临床疗效。方法回顾性分析北京协和医院2013年10月至2014年2月收治的12例因慢性化脓性中耳炎行开放式改良乳突根治术并采用骨粉行乳突腔填塞患者的临床资料。观察术后鼓膜和乳突腔形态,并对术腔完全上皮化时间和术后听力改善情况进行统计学分析。结果 12例患者均干耳;手术后鼓膜形态接近正常,乳突腔体积明显缩小;完全上皮化时间平均29.9 d。8例行人工听骨听力重建患者平均听力提高(11.7±1.8)dB,听力重建效果好。结论开放式改良乳突根治术术腔采用骨粉填塞法简便易行,术腔表面光滑,愈合时间缩短,鼓膜形态良好,听力重建效果佳。
Objective To investigate the clinical outcome of bone pate for mastoid obliteration after canal wall down mastoidectomy. Methods The clinical data of 12 patients who had undergone canal wall down mastoidectomy followed by bone pate obliteration in Peking Union Medical College Hospital from October 2013 to February 2014 were retrospectively analyzed. The post-operative morphologies of tympanic membranes and mastoid cavities were observed,and the complete reepithelialization time and improvement of hearing were analyzed.Results The mastoid cavities were completely reepithelialized in all 12 patients. The morphologies of tympanic membranes were nearly normal. The volumes of mastoid cavities were significantly reduced. The mean time of complete reepithelialization was 29. 9 days. The air-bone gap value increased by( 11. 7 ± 1. 8) dB after the operation in 8 patients who had undergone hearing reconstruction. Conclusions Mastoid obliteration with bone pate after canal wall down mastoidectomy is a simple and convenient procedure that can easily make the mastoid cavity be well-shaped and reepithelialized,shorten the healing time,and achieve good hearing outcome.
关键词(KeyWords):
乳突根治术;乳突腔填塞;骨粉;耳外科手术
mastoidectomy;mastoid obliteration;bone pate;otologic surgical procedures
基金项目(Foundation):
作者(Author):
王珍;王艺贝;陈晓巍;
WANG Zhen;WANG Yi-bei;CHEN Xiao-wei;Department of Otolaryngology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;
Email:
DOI:
参考文献(References):
- [1]Mehta RP,Harris JP.Mastoid obliteration[J].Otolarygol Clin North Am,2006,39:1129-1142.
- [2]Lee WS,Choi JY,Song MH,et al.Mastoid and epitympanic obliteration in canal wall up mastoidectomy for prevention of retraction pocket[J].Otol Neurolol,2005,26:1107-1111.
- [3]Fisch U,Schimid S.Radical mastodon-epitympanectomy with tympanoplasty and partial obliteration:a new procedure?[J].Ann Acad Med,1991,20:614-617.
- [4]Lee WS,Kim SH,Moon IS,et al.Canal wall reconstruction and mastoid obliteration in canal wall down tympanomastoidectomized patients[J].Acta Otolaryngol,2009,129:955-961.
- [5]Yung M,Bennett A.Use of mastoid obliteration techniques in cholesteatoma[J].Curr Opin Otolaryngol Head Neck Surg,2013,21:455-460.
- [6]Nadol JB.Revision mastoidectomy[J].Otolaryngol Clin North Am,2006,39:723-740.
- [7]Haginomori S,Takamaki A,Nonaka R,et al.Residual cholesteatoma:incidence and localization in canal wall down tympanoplasty with soft-wall reconstruction[J].Arch Otolaryngol Head Neck Surg,2008,134:652-657.
- [8]Estrem SA,Highfill G.Hydroxyapatite canal wall reconstruction/mastoid obliteration[J].Otolaryngol Head Neck Surg,1999,120:345-349.
- [9]Cheney ML,Megerian CA,Brown MT,et al.The use of the temporoparietal fascial flap in temporal bone reconstruction[J].Am J Otol,1996,17:137-142.
- [10]Mokbel KM,Khafagy UW.Single flap with three pedicles,bone pate and split-thickness skin graft for immediate mastoid obliteration after canal wall down mastoidectomy[J].Eur Arch Otorhinolaryngol,2012,269:2037-2041.
- [11]Kos MI,Chavaillaz O,Guyot JP.Obliteration of the tympanomastoid cavity:long term results of the Rambo operation[J].J Laryngol Otol,2006,120:1014-1018.
- [12]Deshmuck S,Sharma A,Dabholkar J.Mastoid cavity obliteration:our experience[J].Otolaryngol Pol,2012,66:379-381.
- [13]Ramsey MJ,Merchant SN,McKenna MJ.Postauricular periosteal-pericranial flap for mastoid obliteration and canal wall down tympanomastoidectomy[J].Otol Neurotol,2004,25:873-878.
- [14]Roberson JB Jr,Mason TP,Stidham KR.Mastoid obliteration:autogenous cranial bone pAte reconstruction[J].Otol Neurotol,2003,24:132-140.
- [15]Tantinikorn W,Assanasen P,Prakairungthong S.Mastoid obliteration with postconcal soft tissue and postauricular pericranial flap[J].J Med Assoc Thailand,2012,95:1306-1311.
- [16]Linthicum FH.The fate of mastoid obliteration tissue:a histopathological study[J].Laryngoscope,2002,112:1777-1781.
- [17]Black B.Mastoidectomy elimination:obliterate,reconstruct,or ablate?[J].Am J Otol,1998,19:551-557.
- [18]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填塞术[J].中华耳鼻咽喉头颈外科杂志,2007,42:487-490.
- [19]覃冠锻,莫炼,侯涛,等.开放式乳突手术中改良乳突腔充填及耳甲腔成形术的应用[J].听力学及言语疾病杂志,2011,19:366-367.
- [20]刘高峰,刘艳,原晓峰.玻璃酸钠制剂研究进展及应用[J].中国生化药物杂志,2004,25:252-254.
- [21]Cai MQ,Wang XJ,Li XK.Properties and clinical application of collagen sponge[J].J Clin Rehabil Tissue Eng Res,2011,15,2270-2274.
- 王珍
- 王艺贝
- 陈晓巍
WANG Zhen- WANG Yi-bei
- CHEN Xiao-wei
- Department of Otolaryngology
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences &Peking Union Medical College
- 王珍
- 王艺贝
- 陈晓巍
WANG Zhen- WANG Yi-bei
- CHEN Xiao-wei
- Department of Otolaryngology
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences &Peking Union Medical College