306例儿童中耳胆脂瘤的临床特点及手术方式  

Clinical Characteristics and Surgical Treatment of Pediatric Middle Ear Cholesteatoma: A Study of 306 Cases

作　　者：苏秋豫 郝少娟[1] 叶放蕾[1] 潘滔(审核人) SU Qiuyu;HAO Shaojuan;YE Fanglei(Department of Otology,Otorhinolaryngology Hospital,First Affiliated Hospital of Zhengzhou University,Henan,China)

机构地区：[1]郑州大学第一附属医院耳科,郑州市450052 [2]不详

出　　处：《中华耳科学杂志》2018年第4期532-537,共6页Chinese Journal of Otology

摘　　要：目的本研究回顾性分析儿童中耳胆脂瘤的临床特点及手术方式,为临床医师对该疾病的早期确诊及治疗提供参考。方法回顾性分析2014年1月至2017年8月来我科住院治疗的306例(324耳)儿童中耳胆脂瘤患者的临床资料,对儿童中耳胆脂瘤的临床表现、病变范围、手术方式及治疗效果进行分析总结。结果儿童中耳胆脂瘤临床症状以耳流脓、听力下降为主,手术治疗以开放式乳突根治术彻底清除病变为主(260耳,占80.2%)。术中见听骨链破坏322耳(99.4%),均伴有砧骨结构破坏;面神经裸露90耳(27.8%),最常见于鼓室段(80耳,占88.9%);半规管裸露31耳(9.6%),最常见于水平半规管(27耳,占87.1%);乙状窦及脑板骨质缺损23耳(7.1%)。术后病理结果均证实为中耳胆脂瘤。术后随访半年至1年,发现3耳胆脂瘤复发,其余321耳术后均干耳,恢复可。结论儿童胆脂瘤病变相较于成人发展快、病变广泛、破坏性强,更具侵袭性;根据病变严重程度,遵循术中彻底清除病变且力求改善听力的原则选择相应术式,对于完壁式乳突根治术的适应症掌握应更加严格。Objective To describe clinical characteristics and surgical treatment of pediatric middle ear cholesteatoma.Methods Clinical data of 306 patients(324 ears)with middle ear cholesteatoma were reviewed for clinical manifestation,extent of disease,surgical treatment approaches and therapeutic outcomes.Results The mainly clinical symptoms of pediatric middle ear cholesteatoma were otorrhea and hearing loss.The mainly surgical treatment was canal wall down tympanomastoidectomy.We found that 99.4%of our patients had ossicular chain destruction.The facial nerve canal was eroded in 90 ears(27.8%),and the tympanic segment was more likely to be damaged.Semicircular canals were eroded in 31 ears(9.6%),and the horizontal semicircular canal was more likely to be damaged.Bony wall of the sigmoid sinus was eroded in 23 ears(7.1%).During the 6 months to 1 year follow-up,cholesteatoma recurrence were found in 3 ears.Conclusion Pediatric cholesteatoma is more aggressive.Accurate preoperative examination and evaluation are the key to proper selection of surgery therapy.

关 键 词：儿童 胆脂瘤 中耳 耳外科手术 

分 类 号：R764[医药卫生—耳鼻咽喉科]