外耳道封閉手術

Closure of the External Ear Canal

徐銘燦(Min-Tsan Shu) ； 林鴻清(Hung-Ching Lin) ； 陳昱君(Yu-Chun Chen)

《台灣耳鼻喉頭頸外科雜誌》 43卷1期 (2008/02) Pp. 13-17

https://doi.org/10.6286/2008.43.1.13

摘要

外耳道封閉手術是在清除中耳的病變組織之後，將外耳道封閉成一盲囊(blind sac)，一般並以軟組織或脂肪填塞中耳腔。被用於耳部癌症的手術，顳骨部手術造成難處理的腦脊髓液外漏，或慢性中耳炎需植人工耳蝸的患者。在中耳的手術時若能慎選病例，一些只求一乾淨安全的耳朵，這種手術方法是很值得考慮的。我們以外耳道封閉手術處理4名患者，病例1是在中耳膽脂瘤手術中傷到硬腦膜，造成大量腦脊髓液外流。病例2是名3歲小女生，因罹患左側顳骨橫紋肌肉瘤(rhabdomyosarcoma)，接受左耳根治乳突切開術(radical mastoidectomy)切除腫瘤。病例3是名22歲腦性麻痺的無法行動患者，因先天性耳道狹窄形成巨大膽脂瘤，經開放式乳突切開術(canal down mastoidectomy)清除膽脂瘤後，留下的乳突空腔仍一直耳朵流膿發炎。病例4是名65歲男性，爲受禁制產的聾啞智障病患，多年爲右側耳痛、耳漏所苦，診斷爲化膿性慢性中耳炎。除第一名外其他3名都有照顧上的困難，在手術清除中耳及乳突的病變後都施行外耳封閉手術的處理，以求得一乾淨不需太多照顧的耳朵。4名患者手術後經最少6個月的追蹤，還沒發現不良併發症。

關鍵字

根治乳突切開術 ； 外耳道封閉術 ； 腦脊髓液外流 ； 開放式乳突切開術

並列摘要

The reason that closure of the external auditory canal (EAC) is carried out is to obtain a safe and dry ear after eradication of middle ear disease. This operation is a special surgical procedure and is applied clinically in the cases where there has been CSF leakage as a complication during surgery of the middle ear, when there is malignancy of middle ear and in order to stop discharge from the ear in patients with chronic otitis media. We encountered four such cases. Case 1 involved a tear of the dura meter in mastoid tegmen during a mastoidectomy and a ceassation of the CSF leakage was successful achieved using this procedure. Case 2 involved a three-year-old girl with rhabdomyosarcoma of the middle ear who received a radical mastoidecomy with obliteration of middle ear and as a result of the procedure had a dry ear. Case 3 was a 22 years old male with cerebral palsy who had persistent discharge from the ear after previous operation for EAC cholesteatoma; this patient had a dry ear after receiving revised middle ear surgery combined with closure of EC. Case 4 was a 65-year-old deaf mute male with mental retardation who suffered from chronic ear discharge due to COM; a dry ear occurred after surgery of middle ear and this was combined with closure of EAC. All these four patients recovered normally after this special surgical procedure and there were no complications during a follow-up of more than 6 months.

並列關鍵字

radical mastoidectomy ； external auditory closure ； CSF leakage ； canal down mastoidectomy