岩骨次全切除术的临床应用  

Clinical Applications of Subtotal Petrosectomy

作　　者：宋雯洁 高志强[1] 魏兴梅 吴海燕[1] 张竹花[2] 田旭[1] 赵杨[1] 奥登苏日塔 于姝婷[1] 冯国栋 SONG Wenjie;GAO Zhiqiang;WEI Xingmei;WU Haiyan;ZHANG Zhuhua;TIAN Xu;ZHAO Yang;Aodengsurita;YU Shuting;FENG Guodong(Department of Otorhinolaryngology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院耳鼻喉科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院放射科,北京100730

出　　处：《中华耳科学杂志》2019年第3期284-288,共5页Chinese Journal of Otology

基　　金：国家自然科学基金(81570907,81870735);北京市自然科学基金(7182133)~~

摘　　要：目的探讨岩骨次全切除术的外科技术要点及其在治疗颞骨病变中的应用和疗效。方法回顾性分析2013年4月-2018年7月于北京协和医院耳鼻喉科行岩骨次全切除术的22例(23耳)患者的临床资料。这些患者中胆脂瘤9例,其中3例为术后复发,慢性化脓性中耳炎4例,脑脊液耳漏1例,其他良性肿瘤6例,外耳道鳞癌术后、放疗后复发1例,颅底黄曲霉感染1例。术后行颞骨增强MRI规律随访。结果保留耳囊19耳,切除耳囊4耳;封闭外耳道9耳,不封闭外耳道14耳。以切除病变为目的19耳,其中1例同期植入振动声桥,2例同期切除病变后植入耳蜗,其中1例为听神经瘤,1例为开放性乳突根治术术后人工耳蜗植入后电极外露取出耳蜗并再次植入;所有患者术后规律随访0.5-5年,1例患者术后5年发现胆脂瘤复发,其余患者均未见复发。5耳为清创引流同期切除病变,术后半年内均干耳,其中1例为双侧放射性中耳炎右耳清创术后4月右耳植入人工耳蜗,左耳行岩骨次全切。1例为行脑脊液漏修补,术后随访9月未见复发。结论岩骨次全切除术可用于彻底切除的颞骨内胆脂瘤、颅中窝底良性、低度恶性肿瘤的颅外部分的切除,颞骨岩部感染的清创干耳。可根据病变灵活决定是否切除耳囊及封闭术腔,对于保留耳囊的患者可同期植入人工听觉装置改善听力。Objective To report applications and outcomes of subtotal petrosectomy in the treatment of temporal bone lesions. Methods Data from 22 patients(23 ears) who underwent subtotal petrosectomy from April 2013 to July2018 were retrospectively reviewed. Lesions included cholesteatoma(n=9, 3 recurrent), chronic suppurative otitis media(n=4), cerebrospinal fluid otorrhea(n=1), benign tumors(n=6), recurrent external auditory canal squamous cell carcinoma(n=1) and aspergillus flavus infection in skull base(n=1). All patients were followed up regularly by enhanced MRI for 0.5 to 5 years. Results The otic capsules of 19 cases were preserved, and other 4 cases were removed. External auditory canals of 9 ears were closed, and the other 14 ears were opened. The surgery purpose of 19 ears were lesion obliteration, among which 1 case underwent vibrant soundbridge implantation simultaneously, 2 cases underwent cochlear implantation simultaneously after the resection of the lesion, of which one case was acoustic neuroma, and the other one was due to cochlear electrode exposure after previous cochlear implantation. All patients were followed up for 0.5 to 5 years. One patient suffered recurrence of cholesteatoma 5 years after operation, and no recurrence was found in other patients. 5 ears underwent one-stage debridement and resection of the lesions. Dry ears were achieved within 6 months poetoperative. One case of bilateral radioactive otitis media underwent subtotal petrosectomy for the right ear, and 4 months later he underwent subsequent cochlear implant of the right ear and subtotal petrosectomy of the left ear. One case underwent cerebrospinal fluid leakage repair, and no recurrence was occurred after follow-up of 9 months. Conclusion Subtotal petrosectomy can be applied for complete removal of lesions including temporal bone cholesteatoma, the extracranial part of benign or low-grade malignant middle cranial fossa tumors, and to achieve dry ear in temporal bone infection. The decision to remove the otic capsule is based on ch

关 键 词：岩骨次全切 耳囊 清除病变 通畅引流 

分 类 号：R764[医药卫生—耳鼻咽喉科]