全耳内镜下经外耳道上鼓室胆脂瘤手术分析  

Transcanal Endoscopic Ear Surgery for Attic Cholesteatoma

作　　者：张瑾[1] 王冰[1] 杨启梅[1] 景阳[1] 王宇娟[1] 李世东[1] 刘晖[1] 张文[1] 

机构地区：[1]陕西省人民医院耳鼻咽喉头颈外科,西安710068

出　　处：《中华耳科学杂志》2017年第4期420-425,共6页Chinese Journal of Otology

基　　金：西安市科技计划项目(GG06190)~~

摘　　要：目的探讨全耳内镜下经外耳道处理上鼓室胆脂瘤的手术方法、术后效果以及临床应用特点。方法回顾性分析我科自2016年1月至2017年1月收治的中耳上鼓室胆脂瘤并行全耳内镜下手术的患者。选取符合标准的病例总数47例,男28例,女19例;年龄15~68岁,平均41岁。术中常规取耳屏软骨-软骨膜复合物修补鼓膜、重建上鼓室,于耳内镜下清除胆脂瘤,行鼓室成形术,根据具体情况行上鼓室重建术、听骨链重建术。分别于术后1月、2月、3月和6月复查。结果所有47例患者中,32例(68%)为局限在上鼓室的胆脂瘤,15例(32%)为胆脂瘤同时累及中鼓室、前鼓室;其中21例(45%)听骨链完整,26例(55%)锤骨/砧骨有破坏。其中29例行听骨链重建术。所有患者术后均无面瘫、耳流脓、鼓膜穿孔。术后复查,所有患者的鼓膜形态良好,无内陷、无穿孔,移植物形态良好。术前平均气导听阈为43.45±9.56 d B HL,术后平均气导听阈为27.23±6.89 d B HL,术前术后比较具有统计学差异(P<0.01)。术前平均气骨导差为28.42±6.78 d B HL,术后平均气骨导差为13.62±8.67d B HL,术前术后比较具有统计学差异(P<0.01)。其中29例行听骨链重建术者,术后气骨导差<10d B HL者11例,10~20d B HL者13例,20~30d B HL者3例,>30d B HL者2例。所有患者均未出现病变复发、病变残余,无二次手术者。结论全耳内镜经外耳道手术处理上鼓室胆脂瘤是一种安全有效的手术方法。Objective To report surgical techniques, outcomes and application characteristics of transcanal endoscopic ear surgery for attic cholesteatoma. Methods Data from 47 patients（28 males and 19 females; aged 15-68 years,mean=41 years） who underwent transcanal endoscopic ear surgery for attic cholesteatoma in our department from January 2016 to January 2017 were retrospectively analyzed. During the surgery, the tragus cartilage-perichondrium composite was routinely harvested for tympanoplasty after removal of cholesteatoma under an otoendoscope. Ossiculoplasty and attic reconstruction were individualized. Patients were followed up at postoperative 1, 2, 3 and 6month. Results Of the 47 patients, 32（68%） had limited attic cholesteatoma, and 15（32%） had protympanum/mesotympanum cholesteatoma. Ossicles were intact in 21 cases（45%） and showed malleus/incus erosion in 26 cases（55%）, with ossiculoplasty required in 29 cases. There were no facial paralysis or otorrhea. The tympanic membrane and graft were intact and well healed, with no retraction or perforation after surgery. The mean preoperative air conduction threshold was 43.45± 9.56 d B HL, compared to 27.23 ± 6.89 d B HL postoperatively（P〈0.01）. The mean preoperative air-bone gap was 28.42 ±6.78 d B, compared to 13.62 ± 8.67 d B postoperatively（P〈0.01）. Among the 29 patients who underwent ossiculoplasty,the postoperative air-bone gap was 10 d B in 11 cases, 10-20 d B in 13 cases, 20-30 d B HL in 3 cases and 30 d B in 2cases. There were no recurrence, residual cholesteatoma or secondary surgery needed. Conclusions Stand alone transcanal endoscopic ear surgery was a safe and effective for attic cholesteatoma.

关 键 词：耳内镜手术 上鼓室 胆脂瘤 鼓室成形术 

分 类 号：R764[医药卫生—耳鼻咽喉科]