中耳胆固醇肉芽肿诊治分析(附16例报告)  

Retrospective study of diagnosis and treatment of cholesterol granuloma in the middle ear( with report of 16 cases)

作　　者：刘晖[1] 王宇娟[1] 王鑫[1] 景阳[1] 

机构地区：[1]陕西省人民医院耳鼻咽喉科,陕西西安710068

出　　处：《中国耳鼻咽喉颅底外科杂志》2014年第4期298-300,304,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：国家自然科学基金面上项目(81072649);陕西省自然科学基础研究计划项目(2010JM4013)

摘　　要：目的探讨中耳胆固醇肉芽肿诊断及手术治疗方案的选择和疗效。方法回顾性总结分析2009-2013年诊治的16例中耳胆固醇肉芽肿患者的临床资料。根据患者具体情况采取不同手术方式,其中4例患者采用鼓室探查及鼓膜置管术,9例采用完壁式乳突切除、后鼓室开放、鼓膜切开置管及鼓窦口通风引流术,3例采用开放式乳突切除及听骨链重建术。结果术后所有患者均随访半年以上,其中2例行单纯鼓膜置管术患者术后半年复发,再次采用完壁式乳突切除加后鼓室切开及鼓膜置管术,同时置入鼓窦口通风引流管,观察1年未复发。其他患者术后随访1年以上均无复发。结论中耳胆固醇肉芽肿依据临床特点和CT诊断采取不同的治疗方法,主要是重建通气引流通道。其中完壁式乳突切除、后鼓室切开、鼓膜置管术及鼓窦口通风引流对保存患者听力、防止病变复发具有很好的治疗效果。Objective To investigate the diagnosis of cholesterol granuloma in middle ear and choice of surgical method and curative effect. Methods Clinical data of 16 patients with cholesterol granuloma in middle ear receiving surgical treatment in our department from 2009 to 2013 were analyzed retrospectively. As for the surgical method, tympanotomy combined with tympanic tube insertion was applied to 4 cases; 9 cases received canal wall up nmstoidectomy, tympanic tube insertion and posterior tympanum opening; 3 cases received canal wall down mastoidectomy combined with ossicular reconstruction. Results Relapse occurred in two of the patients treated with tympanic tube insertion after six months, and then canal wall up mastoidectomy was applied. Other patients were followed up more than one year without recurrence. Conclusions The diagnosis of cholesterol granuloma in the middle car depends on clinical manifestation and CT scan. The treatment methods may be different according to different preoperative assessment. It is necessary to remove the lesion and adequately reconstruct the draining channel. For hearing preservation and preventing relapse, treatments including canal wall up mastoidectomy, tympanic tube insertion, posterior tympanum opening and tympanic antrum tube for ventilation and drainage show good therapeutic effect.

关 键 词：中耳 胆固醇肉芽肿 诊断 手术治疗 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]