中华耳科学杂志2012，Vol.10Issue(1)：15-18,4.
先天性外耳道狭窄与闭锁—远期疗效影响因素与手术策略
Management of congenital meatal stenosis and atresia - impact factors on long-term results and surgical strategy
摘要
Abstract
Purpose To analyze impact factors on long-term results following meatoplasty and tympanoplasty in terms of canal patency, post-surgery hearing and complications, and to determine surgical indications and protocol for such procedures in patients with congenital meatal stenosis and atresia. Materials and Methods: Seventy three patients with congenital stenosis or atresia seen between Sep. 2007 and Sep. 2010 were enrolled in this study. Inclusion was based on CT scores (greater than 6 on the Jahrsdoerfer' s scoring system). Exclusion criteria included intractable infections and tympanic cavity destruction by cholesteatoma. The mean age of the 73 patients was 12.8 years and the mean follow-up time was 22.0 months .Surgical protocol: The endoaural incision was used to approach the canal and attic. The eardrum was reconstructed with temporal fascia or periosteum covered by Thiersch's skin graft. Skin translocation from canal was used in case of pre-existing small eardrum. The reconstructed canal was packed with Vaseline gauze with antibiotics for 3 to 4 weeks. After gauze removal, expansion foam or sterile cotton was used to maintain patency of the new canal for more than half year. Results In patients with meatal stenosis, 19 (95%) acquired stable and serviceable hearing with an air-bone gap (ABG) of less than 30 dB (less than 10 dB in 4 (20%)) and few complications. In patients with atresia, only 27 (50.9%) acquired similar results as in those with stenosis. There were also more complications in this group of patients. Post-operative hearing, long term outcomes and complications favored meatal stenosis when compared to atresia (p < 0.05).Conclusion The most important factor impacting prognosis was presence of an eardrum and ear canal skin.Indications for functional surgery should be stricter in atresia than in stenosis.关键词
外耳道狭窄/外耳道闭锁/外耳道成形术/小耳畸形Key words
Stenosis/Atresia/Metoplasty/Microtia分类
医药卫生引用本文复制引用
张天宇,李辰龙,符窈窈,迟放鲁,王正敏..先天性外耳道狭窄与闭锁—远期疗效影响因素与手术策略[J].中华耳科学杂志,2012,10(1):15-18,4.基金项目
上海市卫生系统优秀人才培养计划:XBR2011068上海市科学技术委员会基础研究重大项目:09DJ1400602 （）
