摘要
目的探讨中耳手术中上鼓室、鼓窦及乳突天盖区脑膜裸露的修复处理方法。方法对582例鼓室成形术患者的资料进行回顾性分析。中耳胆脂瘤患者247例,术中有脑膜裸露者31例;慢性中耳乳突炎335例,有脑膜裸露者18例。应用筋膜组织、乳突骨皮质骨片、骨粉、软骨、颞肌等修复保护裸露的脑膜。结果术后未出现脑膜脑膨出、脑膜炎等并发症,也未出现骨粉坏死等情况。术后3个月,术腔干耳率为91.8%(45/49),6个月达到100%(49/49),乳突术腔形成宽敞平滑的耳道。结论中耳胆脂瘤术中脑膜裸露术腔的概率较非中耳胆脂瘤高;筋膜组织、乳突骨皮质骨片、骨粉、软骨、颞肌等在上鼓室及乳突区病灶清除后裸露脑膜的处理中是良好的修复及保护材料,有利于避免术后脑膜脑膨出、脑膜炎等并发症的发生,利于乳突术腔形成宽敞平滑的耳道。
Objective To study the repairing method of the dural bone defect in the regions of the tegmen of tympanum and tympanic sinus or mastoid in tympanoplasty. Methods Five hundred and eighty-two eases of tympanoplasty were analyzed retrospectively. Among the 247 patients with middle ear cholesteatoma, there were 31 cases with naked meninges, and there were 18 eases of meningeal nudity among 335 eases with chronic otitis media. Fascia, cortical bone, bone pieces, cartilage and temporal muscle tissue were applied in the repairing of the exposed meninges. Results There were no complications （ such as meningoeneephalie meningitis and meningitis） after the repair of the exposed meninges. There were no eases of necrosis of bone. There were 45 eases of eompletely dry ear （ 91.8% ） 3 months after operation and 49 cases （ 100% ） 6 months postoperation. The mastoid cavity formed a spacious and smooth ear canal three months after the treatment. Conclusions The ratio of dural bone defect in middle ear cholesteatoma was higher than that of the non-middle ear eholesteatoma patients. The fascia, cortical bone, bone pieces, and temporal muscle tissues are good repair and protection materials for the treatment of bare meninge after the tympanic and mastoid lesions have been removed. It is beneficial for avoiding the occurrence of postoperative meningoeele, meningitis and other complications, and will help the mastoid process cavity to form a spacious and smooth ear canal. （Chin J Ophthalmol and Otorhinolaryngo1,2017,17 ： 184-186）
出处
《中国眼耳鼻喉科杂志》
2017年第3期184-186,共3页
Chinese Journal of Ophthalmology and Otorhinolaryngology
关键词
鼓室成形术
中耳炎
乳突
骨
脑膜脑膨出
脑膜炎
Tympanoplasty
Otitis media
Mastoid
Bone
Meningoencephalocele
Meningitis
