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目的探讨一种改良的经乳突外耳道联合径路、采用1期转蒂Z形皮瓣结合2期植皮法在先天性外耳中耳畸形中的听力重建效果。方法 2001年3月至2010年1月间,110例确诊为先天性外耳中耳畸形病例,分为纵行切口组(24例)和Z形皮瓣组(86例)。所有病例按Schuknecht畸形分型,经乳突外耳道联合径路,根据术中听骨链情况行Ⅰ-Ⅲ型鼓室成形术。比较两组术前的畸形分型、听力结果、鼓室成形术式;并对两组近期、远期听力学效果及并发症发生率进行比较。结果与纵行切口组比较,Z形皮瓣组术前听力水平、畸形分型与乳突气化分类差异无显著意义(P>0.05)。术后近期听力,无论提高10dBHL以上或提高30dBHL以上,纵形切口组与Z形皮瓣组的近期听力效果差异均无显著意义(P>0.05);但远期听力效果两组差异均有显著意义(P<0.05);Z型皮瓣组的近期与远期听力效果差异无显著意义(P>0.05)。两组并发症发生率差异有显著意义(P<0.05)。结论术前详尽的耳畸形程度判定、术中对有效中耳传音结构的最大程度保护及经乳突外耳道联合径路、1期转带蒂Z形皮瓣结合2期植皮法具有良好优势,能结合其它方法的优点,在经过合理选择的病例中联合应用,获得较好的远期听力重建效果。
Objective To explore an improved auditory reconstruction of the mastoid external auditory canal combined approach with primary Z-flap and 2-stage skin grafting in congenital external ear middle ear deformity. Methods Between March 2001 and January 2010, 110 cases of congenital auricular malformation were identified. They were divided into longitudinal incision group (24 cases) and Z-shaped flap group (86 cases). All cases according to Schuknecht deformity classification, the mastoid joint canal pathways, according to intraoperative ossicular chain type Ⅰ-Ⅲ tympanoplasty. The preoperative malformations, hearing results and tympanoplasty were compared between the two groups. The short-term and long-term audiological effects and complication rates were compared between the two groups. Results Compared with longitudinal incision group, there was no significant difference in preoperative hearing level, malformation type and mastoid gasification classification in Z-shaped flap group (P> 0.05). There was no significant difference in short-term hearing between longitudinal incision group and Z-flap group (P> 0.05), but no significant difference was found in the long-term hearing effect between the two groups (P <0.05). There was no significant difference between the short-term and long-term hearing effects in the Z-type flap group (P> 0.05). The difference in the incidence of complications between the two groups was significant (P <0.05). Conclusions The preoperative detailed assessment of the degree of ear deformity has the advantage of maximum effective protection of the effective middle ear acoustic structure and the combination of the external mastoidectomy path and the primary revolving pedicle Z flap with the 2 stage skin grafting method Combined with the advantages of other methods, in the case of a reasonable choice of joint application, to obtain better long-term hearing reconstruction.