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目的:观察在筋膜外植法鼓室成形术中施行外耳道成形术的作用。方法:在筋膜外植法鼓室成形术同时行外耳道成形术59耳(部分伴完壁式乳突根治术),通过耳道内和耳后联合切口,分离外耳道后壁皮瓣并向前上翻起固定,游离外耳道前壁皮肤,磨除外耳道前下方悬骨及周边骨质,扩大骨性外耳道,开放鼓沟,充分暴露鼓环,鼓膜彻底去上皮化。清除中耳病变后,外植铺放颞筋膜,回复外耳道前壁皮肤和后壁皮瓣,明胶海绵固定。术后1周开始滴耳,外耳道明胶海绵4～6周自然排空。结果:随访0.5～3.5年,所有患者切口Ⅰ期愈合,外耳道宽敞,鼓膜形态好,无皮瓣坏死、外耳道狭窄和胆脂瘤珠形成等并发症。结论:外耳道成形术是筋膜外植法鼓室成形术的必备步骤,有助于鼓膜彻底去上皮化、筋膜铺放及避免胆脂瘤珠形成,并且便于术后观察。
Objective: To observe the effect of external auditory canal angioplasty during fasciaectomy tympanoplasty. Methods: 59 cases of external auditory canal angioplasty (part of total eyelid mastoidectomy) under arthroscopic tympanoplasty were performed. The flaps of the posterior wall of the external auditory canal were separated and turned upwards A fixed, free external auditory meatus anterior wall of the skin, grinding and removal of the outer ear before the lower bones and the surrounding bone, expand the external auditory canal, open the ditch, fully exposed drum ring, tympanic membrane thoroughly to epithelialization. Removal of the middle ear lesions, implants the temporal fascia, the anterior external auditory meatus skin and posterior wall flap, gelatin sponge fixation. Ear drops 1 week after surgery, external gelatin sponge 4 to 6 weeks of natural emptying. Results All cases were followed up for 0.5-5.5 years. All the incisions healed with first intention, wide external auditory canal, good tympanic membrane morphology, no flap necrosis, external auditory canal stenosis and the formation of cholesteatoma. CONCLUSION: External auditory canal angioplasty is an essential step in tympanoplasty using fascia explantation. It is helpful to completely remove the tympanic membrane, fasten the fascia and avoid the formation of cholesteatoma, and it is easy to observe after operation.