先天性中耳胆脂瘤12例临床分析  

Clinical Analysis of 12 Cases of the Congenital Middle Ear Cholesteatoma

作　　者：戴炳译 关兵[1] 于爱民[1] 严齐 王茂华 dai bingyi;guan bing;yu aimin;yan qi;wang maohua(Northern people's hospital of Jiangsu province,Department of otolaryngology-Head andNeck Surgery,Yangzhou University Medical School,Yangzhou,225001,China)

机构地区：[1]江苏省苏北人民医院耳鼻咽喉-头颈外科,扬州225001 [2]扬州大学医学院 [3]中南大学湘雅二医院耳鼻咽喉科

出　　处：《听力学及言语疾病杂志》2018年第5期488-491,共4页Journal of Audiology and Speech Pathology

摘　　要：目的探讨先天性中耳胆脂瘤的诊断方法及手术方式。方法回顾性分析2008年1月~2016年7月在苏北人民医院耳鼻咽喉-头颈外科诊治的12例单侧先天性中耳胆脂瘤患者的临床资料,探讨先天性中耳胆脂瘤的临床特点、诊断和手术方法。结果 12例先天性中耳胆脂瘤患者均符合Levenson诊断标准,其中2例伴耳鸣,1例伴耳后肿物,1例伴面瘫;12例术前0.5、1、2kHz平均听阈为55±4.2dB HL,平均气骨导差为45±3.7dB;术前颞骨高分辨率CT(HRCT)示8例胆脂瘤位于中后鼓室,主要是在砧镫关节处,2例位于中上鼓室,2例病变广泛侵及上鼓室及鼓窦。所有患者经手术治疗,6例经耳内径路鼓室探查清除胆脂瘤后行鼓室成形术,2例行完璧式乳突根治+鼓室成形术,4例行开放式乳突根治+鼓室成形术;其中1例伴面瘫患者病变累及面神经管壁,面神经受损,术中行面神经端端吻合术。术后6个月12例患者0.5、1、2kHz 6个月平均听阈35±6.3dB HL,平均气骨导差20±2.5dB。术后1年所有病例复查HRCT,未见胆脂瘤残留或复发。术后16个月时伴面瘫患者面神经功能由术前的Ⅲ级恢复至Ⅱ级。结论先天性中耳胆脂瘤临床少见,主要表现为传导性聋,HRCT为首选辅助检查,手术是唯一有效治疗方式,根据病变范围选择合适的手术方式,预后较好。Objective To investigate the clinical symptoms,diagnosis and treatment of congenital middle ear cholesteatoma.Methods A retrospective review of clinical and surgical records of 12 patients with congenital cholesteatoma enrolled at Otolaryngology Head and Neck Surgery of Northern jiangsu People's Hospital from January 2008 to July 2016 was analyzed.Results In 12 cases of congenital middle ear cholesteatoma,the preoperative average pure acoustic threshold was 55±4.2 dB,and the average air bone gapwas 45±3.7 dB,all cases were prompted conduction deafness.High resolution temporal bone CT scan was performed in all cases.All cases were treated surgically,6 cases were selected from the anterograde approach to removecholesteatoma after exploration with tympanoplasty,and 2 cases were treated was canal wall-up mastoidectomy with tympanoplasty,while 4 cases were treated wish canal wall-down mastoid open method intraoperative;1 tumor was involved the facial nerve tube wall,so that facial nerve terminal anastomosis was performed.The average pure acoustic threshold was 35++6.3 dBHL,and the average air bone gap was 20+2.5 dB after 6 months.Follow-up after 1 year,all cases had the HRCT scan,no residual or recurrence was found.Facial paralysis patients with facial paralysis recovered from gradeⅢto gradeⅡat 16 months postoperation.Conclusion The congenital cholesteatoma is rare in clinical and presents conductive hearing loss mostly.HRCT image has an important value in the diagnosis and treatment and surgery is the best effective treatment of congenital middle ear cholesteatomaswhich obtains better hearing reconstruction.

关 键 词：先天性胆脂瘤 高分辨率CT 手术 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]