摘要
目的探讨先天性小耳畸形伴外耳道闭锁患儿Medpor支架全耳廓再造联合不同听力重建技术的临床疗效。方法收集2017年7月至2019年12月上海交通大学医学院附属第九人民医院手术治疗的先天性小耳畸形伴外耳道闭锁的患儿共68例,男性53例,女性15例,年龄7~12岁,中位年龄8.8岁。其中28例行高密度聚乙烯(Medpor)支架植入耳廓再造术的同时一期完成听力重建术,包括20例患者完成传统的外耳道成形和鼓室成形听力重建术,8例患者术中植入骨桥的骨传导装置,术后3~4周佩戴骨桥体外处理器;余下40例小耳畸形患者仅行Medpor支架植入耳廓成形术,作为对照组。术后评价患儿耳廓形态、听觉功能的改变以及并发症的发生情况。结果术后随访3~30个月,一期完成听力重建与形态再造组的患儿耳廓外形良好,术后12个月耳廓14个精细结构平均分值为9.43分和10.67分,耳廓对称度平均分值为6.83分和6.00分,与单纯耳廓再造组(8.23分/6.20分)相比,差异无统计学意义(P>0.05);骨桥组术后平均听阈改善43.3 dB,平均言语识别阈值下降42.3 dB;外耳道及鼓室成形组平均听阈改善4.1 dB,平均言语识别阈值下降11.4 dB。所有患者均未出现眩晕、耳鸣、脑脊液漏等并发症;外耳道及鼓室成形组术后出现感音神经性聋、耳廓支架断裂、耳道再狭窄、耳道闭锁各1例;单纯耳廓组中耳廓支架外露、面神经颞支损伤各1例;10例患者出现不同程度头皮切口处毛发生长困难。结论Medpor支架植入耳廓再造同时进行外耳道鼓室成形或骨桥植入重建听力技术安全有效,重建听力的方式需评估患者内中耳发育情况而定,对于中耳乳突发育欠佳者建议骨桥植入以获得稳定而明显的助听效果。
Objective To investigate the clinical effects of single-stage auricular reconstruction and hearing rehabilitation in children with microtia and external auditory canal atresia.Methods Sixty eight cases of microtia with external auditory canal atresia(53 males and 15 females,age from 7 to 12 years,with a median age of 8.8 years),who received operations in Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine from July 2017 to December 2019 were collected.A total of 28 cases received auricle reconstruction with high-density polyethylene(Medpor)framework and hearing reconstructions,among which 20 patients received the traditional external auditory canal and middle ear repair(EACR),and eight patients were implanted bone conduction device bone bridge(BB)simultaneously.In the control group,40 patients only received Medpor frame implantation for auricle plasty.Postoperative changes in auricle morphology and auditory function and postoperative complications were evaluated.Results After three to thirty months follow-ups,the auricles shape recovered well in all three groups.The average scores of 14 fine structures in the auricles were 9.43(EACR)and 10.67(BB)points.The average score of auricle symmetry were 6.83(EACR)and 6.00(BB)points.There was no significant difference compared to the auricle reconstruction group(8.23/6.20 points).P>0.05.After surgery,the average hearing improvement in the BB group was 43.33 dB HL and the average speech recognition threshold declined 42.28 dB HL.In the EACR group,the average hearing improvement was 4.13 dB HL and the average speech recognition threshold declined 11.36 dB HL.No vertigo,tinnitus,cerebrospinal fluid leakage and other complications occurred in all the patients.In the EACR group,sensorial hearing loss,auricle stent fracture,ear canal restenosis and ear canal atresia occurred in one patient respectively.In the auricle group,one auricle stent exposure and one facial branch nerve injury occurred.Nearly ten patients had difficulty in hair growth at scalp
作者
江晨艳
陈斌
王树伦
李蕴
阎小军
易彬
石润杰
吴皓
Jiang Chenyan;Chen Bin;Wang Shulun;Li Yun;Yan Xiaojun;Yi Bin;Shi Runjie;Wu Hao(Department of Otorhinolaryngology Head and Neck Surgery,Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CSCD
北大核心
2021年第4期333-339,共7页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
申康三年行动计划专科疾病临床“五新”转化项目(16CR31198)
上海交通大学医学院附属第九人民医院临床研究助力计划资助(JYLJ028)。
关键词
耳畸形
获得性
先天性小耳畸形
外科
整形
耳再造
听力重建
Ear deformities,acquired
Congenital microtia
Surgery,plastic
Ear reconstruction
Hearing reconstruction
