目的回顾性分析了北京同仁医院耳鼻咽喉科近十年完成的伴耳道成形和鼓室成形的全耳廓再造手术临床资料,手术方式以及外形、听力随访结果,探讨先天性外中耳畸形的耳廓再造术与外耳道重建、鼓室成形术整合同期手术的优势以及手术技术要点。材料与方法我院耳显微外科近十年完成的伴耳道成形和鼓室成形的全耳廓再造手术共287例,其中男212例,女75例。年龄6~27岁,平均13.9岁。术前纯音测听检查,平均气导听阈64 dB HL,平均骨导听阈15 dBHL。结果287例中282例(98.3%)耳廓重建I期愈合,经挽救手术II期术后耳廓成活率为100%,耳廓形态满意率为85.0%(244/287)。术后3周纯音测听检查,语频区平均骨气导差缩小20 dB HL以上者占222(77.35%)例。249例患者经过了术后6个月的听力随访,155例(62.24%)的听力水平下降小于5 dB HL,维持了术后的听力水平。结论伴有听力重建的耳廓再造术,不仅使患者同时获得一定的实用听力,缩短患者住院时间,减少患者手术花费,更重要的是,同期手术使得手术切口更合理、同时再造的耳廓形态逼真、自然、立体感强,具有较好的美容效果。
Objectives To discuss the advantages of an integrated protocol for auricle reconstruction combined with hearing recon-struction. Methods We retrospectively analyzed the clinical information and follow-up results of 287 cases (287 ears) of con-genital aural atresia with microtia who underwent auricle reconstruction combined with hearing reconstruction in recent 10 years in Tongren Hospital. Results Among all 287 cases, 282 ears were closed by primary healing. The other 5 ears were suc-cessfully reconstructed with revision surgeries without graft failure complications. The three-dimensional profiles were well de-fined in 244 ears. Total satisfaction rate was 85.0%. After the surgery, 222 cases obtained a hearing improvement of at least 20 dB HL, and 62.24% of the cases remained the level during the follow-up period. Conclusions Auricle reconstruction com-bined with hearing reconstruction can help patients with microtia to obtain practical hearing improvement as well as cosmetic improvement. The integrated procedures can facilitate the incision design and obtain a natural-looking three-dimensional shape of the reconstruction auricle.