38例岩尖胆脂瘤临床诊疗分析  

Clinical analysis of 38 cases of petrous apex cholesteatoma

作　　者：陈志婷[1] 吴南[1] 王方园[1] 李坤[1] 任丽丽[1] 李佳楠[1] 杨仕明[1] 

机构地区：[1]解放军总医院耳鼻咽喉头颈外科解放军耳鼻咽喉研究所聋病教育部重点实验室,北京100853

出　　处：《临床耳鼻咽喉头颈外科杂志》2015年第2期114-116,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的：探讨岩尖胆脂瘤的临床特点、诊断方法以及治疗策略。方法：对我科收治的38例岩尖胆脂瘤患者的临床表现、诊断方法以及手术治疗进行回顾性分析。结果：138例患者中,33例患者术前均有不同程度的单侧听力下降及面瘫,其中27例先出现听力下降,后出现面神经麻痹,6例发病初期以面瘫为主要表现;217例患者伴有持续性高调耳鸣,4例伴有剧烈耳痛,15例伴有眩晕;3所有患者高分辨率CT均可见岩尖骨质破坏,同时MRI提示岩尖存在占位性改变;4术中彻底清除病变,12例患者行颅中窝进路行胆脂瘤切除术,23例患者行迷路-耳蜗入路,3例在鼻内镜下行岩尖胆脂瘤切除术,7例行面神经端端吻合术,8例患者行面神经减压术,11例行面神经-舌下神经吻合术,3例行耳大神经移植术,随访1~2年,未见复发。结论：岩尖胆脂瘤的临床表现无明显特异性,高分辨率CT及MRI在岩尖胆脂瘤诊断中具有重要价值,应根据胆脂瘤的分类、部位以及患者听力、面神经功能选择最佳的手术治疗策略。Objective：To explore the clinical characterlstms, diagnosis method and treatment of petrous apex cholesteatoma. Method：A retrospective analysis was taken with respects to the clinical characteristics, diagnosis and surgical management of 38 patients who underwent surgery for petrous apex cholesteatoma in our department. Result：（1）31 patients had unilateral hearing loss and facial paralysis of different degree, 27 patients were firstly characterized with hearing loss, and followed by facial paralysis. 6 cases had facial paralysis as the main perform- ance. （2）17 patients had syndrome of tinnitus, and 15 patients had syndrome of vertigo and 4 cases of severe pain of ear. （3）All patients had petrous bone destroy with high resolution CT scan, while MRI suggests the presence of pathological changes in petrous apex. （4）All patients were taken surgeries to remove the lesion, and translabyrinth approach was chosen for 23 patients, middle cranial fossa approach is 12, while 3 case has choose endoscopic ap- proach. 8 cases were operated with facial nerve decompression. 7 cases was taken end to end anastomosis. 3 cases of great auricular nerve transplantation. There is no recurrence in follow-up of 1 years to 2 years. Conclusion：The clinical manifestations of petrous apex cholesteatoma lack specificity, and high resolution CT and MRI has impor- tant value in the diagnosis of petrous apex cholesteatoma. The strategy of surgical operation should be taken ac- cording to the classification, location of petrous apex cholesteatoma as well as hearing level and facial nerve func- tion with patients.

关 键 词：岩尖 胆脂瘤 临床表现 手术方式 

分 类 号：R764.43[医药卫生—耳鼻咽喉科]