上鼓室胆脂瘤手术治疗  

Efficacy of the attic open technique with intact canal wall in treating localized cholesteatoma

作　　者：蒋立新[1] 马玉坤[1] 杨宁[1] 罗冬[1] 刘秀虹[1] 蔡琴芳[1] 涂博[1] 

机构地区：[1]暨南大学附属第一医院耳鼻咽喉头颈外科,广东广州510630

出　　处：《中国耳鼻咽喉头颈外科》2010年第3期131-132,139,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：广东省医学科研基金资助项目(A2007335)

摘　　要：目的评估保留完整外耳道后上壁的上鼓室开放术治疗局限性胆脂瘤的临床疗效。方法38耳上鼓室胆脂瘤及内陷袋形成患者,耳内镜检查鼓膜松弛部内陷9耳,鼓膜松弛部穿孔27耳,外耳道胆脂瘤侵入上鼓室2耳。颞骨轴位和冠状位CT检查,病变局限在上鼓室区,天盖无明显破坏或下垂。虚拟耳镜显示听骨链完整13耳,听骨链变形12耳,听小骨不同程度破坏13耳。手术时在颞线下磨开外耳道后上嵴至颧弓后根骨壁,保留菲薄完整的外耳道后上壁和天盖,开放上鼓室经上而下处理胆脂瘤及鳞状上皮,完成听骨链成形术。结果术后外耳道完整,鼓膜松弛部穿孔或内陷袋行鼓膜修补术均一期愈合,术后平均听力较术前平均提高15～25dBHL,随访1.0～4.0年未见胆脂瘤复发。结论保留完整外耳道壁的上鼓室开放技术,在彻底清除上鼓室和听骨链病变的同时,完整保持外耳道和鼓室结构,临床疗效满意。OBJECTIVE To evaluate the clinical efficacy of the attic open technique with intact canal wall in treating localized cholesteatoma.METHODS In 38 ears with attic cholesteatoma,retraction of flaccid part were found in 9 ears,flaccid part perforation in 27 ears,external auditory canal cholesteatoma in 2 ears by ear endoscopy.Temporal bone axial and coronal CT were carried out in all of the patients .localized lesions were found in the attic,without tegmen tympani destruction or ptosis.Virtual CT endoscopy showed intact ossicular chain in 13 ears,distortion of ossicular chain in 12 ears and damage to different degrees in 13 ears.The ossiculoplasty was performed that lateral wall of the attic was opened,the posterior-upper wall of external auditory canal was remained,the cholesteatoma was eliminated from upper to lower.RESULTS The integrity of external auditory canal were remained after surgery.Tympanic membrane perforation was healed.Compared with the preoperative average,the speech-frequency hearing was increased about 15-35 dBHL.There was no recurrence of cholesteatoma during 1.0-4.0 years of follow-up.CONCLUSION The clinical curative effect for the surgical technique in keeping intact canal wall tympanoplasty is satisfied,as it maintains the normal structure of the auditory canal and tympanic cavity in one stage while eliminating attic cholesteatoma thoroughly.

关 键 词：中耳炎 胆脂瘤 中耳 鼓室成形术 

分 类 号：R764[医药卫生—耳鼻咽喉科]