Ⅲ、Ⅳ级外耳道胆脂瘤的手术治疗  

Surgical Treatment of Grades III and IV External Auditory Canal Cholesteatoma

作　　者：李伟[1] 张婷[1] 戴春富[1] 

机构地区：[1]复旦大学附属眼耳鼻咽喉科医院耳颅底外科,上海200031

出　　处：《中华耳科学杂志》2012年第4期462-465,共4页Chinese Journal of Otology

基　　金：上海市级医院新兴前沿技术联合攻关项目(No:SHDC12010119)

摘　　要：目的探讨Ⅲ、Ⅳ级外耳道胆脂瘤(Naim分级)临床特点、手术指征及手术方式,评价其疗效。方法回顾分析2003年10月～2011年3月住院的52例Ⅲ、Ⅳ级外耳道胆脂瘤(Naim分级)患者,共55耳手术。所有患者行外耳道胆脂瘤摘除同时行外耳道成形,术后外耳道置膨胀海绵。术后三个月门诊复诊,并行纯音测听检查,随后要求每年门诊复诊一次,如有明显不适可门诊随诊,本组病例随访时间为14至105月之间,平均45.17±3.23月。结果本组病例中,最常见的症状是听力下降(80.00%,44耳),55耳中有2耳分别于术后1年和2年后复发,1耳外耳道术后1年出现膜性闭锁,2耳分别于术后6月、1年出现外耳道深部狭窄,其余患者目前外耳道通畅,上皮化良好,干燥,鼓膜完整。结论外耳道胆脂瘤一旦破坏外耳道骨质,导致外耳道口狭小,胆脂瘤不能自行排空应行手术清除病灶,同时行外耳道+耳甲腔成形,建立通畅引流,消除胆脂瘤形成的因素。术后外耳道内填塞膨胀海绵能有利于上皮沿外耳道生长,防止外耳道闭锁。Objective To report clinical characteristics, surgical techniques, and treatment outcomes in patients with advanced external auditory canal cholesteatoma （EACC）. Methods We reviewed 52 cases （55 ears） of advanced EACC （Naim III and IV） that were surgically treated. All patients undertook PTA test at 3 months postoperatively. Patients were in- structed to return for follow up annually. The duration of follow-up ranged from 14 to 105 months （mean= 45.17 ＋ 3.23 months）. Results In the present study, hearing loss was the most common symptom, present in 80% of the cases （44 ears）. There were 2 recurrences at 1 and 2 years postoperatively, respectively. One patient was found to have developed membra- nous atresia of external auditory canal 1 year postoperatively. Deep meatal stenosis occurred in two ears at half a year and 1 year postoperatively, respectively. All other ears remained patent and dry at the time of this writing, with good skin coverage and intact tympanic membranes. Conclusions In external auditory canal cholesteatoma, when the bony ear canal wall has been compromised and stenosis developed with cholesteatoma debris buildup, surgery is the best treatment option with canaloplasty and meatusplasty to eliminate the factors contributing to external auditory canal cholesteatoma. Packing with inflation sponge in external auditory canal can facilitate the epithilialization.

关 键 词：胆脂瘤 外耳道 外耳道成形术 

分 类 号：R739.61[医药卫生—肿瘤] R764.91[医药卫生—临床医学]