耳内镜下处理先天性中耳胆脂瘤的临床疗效分析  

Clinical Outcomes of Endoscopic Ear Surgery for Congenital Middle Ear Cholesteatoma

作　　者：胡兴家 余涛[1] 周顺华[1] HU Xingjia;YU Tao;ZHOU Shunhua(Department of Otolaryngology Head and Neck Surgery,First People’s Hospital Of Changde City,Changde,Hunan,415000,China)

机构地区：[1]常德市第一人民医院耳鼻咽喉头颈外科,常德415000

出　　处：《中华耳科学杂志》2020年第3期517-520,共4页Chinese Journal of Otology

基　　金：常德市科技局技术研究与开发资金项目(编号:2017S030)。

摘　　要：目的探讨总结耳内镜下处理先天性中耳胆脂瘤(Congenital Middle Ear Cholesteatoma,CMEC)的特点,并对手术的疗效进行分析及评估手术安全性。方法回顾性分析常德市第一人民医院耳鼻咽喉-头颈外科自2012年1月至2018年7月诊治的10例CMEC患者的临床资料,总结该病的临床特征,探讨耳内镜在处理先天性CMEC中的手术方法,观察术后复发率,残留率及并发症等。结果全耳内镜下完成CMEC手术9例,耳内镜与显微镜联合手术1例。所有病例术前平均听阈54±3.8dB HL,平均气鼓导差42±3.4dB,均行一期鼓室成形术,术后6个月复查平均听阈30±5.7dB HL,平均气鼓导差18±2.4dB,术后随访1年以上,复查颞骨高分辨率CT未见胆脂瘤残留或复发。结论CMEC多有听骨链破坏且病变隐匿,耳内镜手术能最大化保留原有的中耳及外耳道正常结构,为听力重建提供较好的环境,同时能清理隐匿病灶,是一种安全有效的手术方式。Objective To report characteristics of congenital middle ear cholesteatoma treated by endoscopic surgery,as well as treatment outcomes and operation techniques.Method Ten cases of congenital middle ear cholesteatoma treated from January 2012 to July 2018 were retrospectively reviewed,including clinical characteristics,endoscopic surgery strategies and treatment outcomes.Result Transcanal endoscopic approach was used in 9 cases and combined microscopic and endoscopic approach in 1 case.Preoperative average pure tone threshold was 54±3.8 dB HL,with an air bone gap of 42±3.4 dB.After primary tympanoplasty,average pure tine threshold was 30±5.7 dB HL with an average air bone gap of 18±2.4 dB at 6 months.Followed up of at least 1 year with high resolution temporal bone CT showed no residual lesion or recurrence.Conclusion Congenital middle ear cholesteatoma is insidious while the ossicular chain is often destroyed.The unique advantage of endoscopic surgery allows complete removal of otherwise hidden lesions with improved visualization for hearing reconstruction while preserving normal original structures of the middle ear and external auditory canal to the maximum possible extent.It is therefore a safe and effective method to handle middle ear congenital cholesteatoma.

关 键 词：耳内镜手术 先天性胆脂瘤 中耳 鼓室成形术 

分 类 号：R764[医药卫生—耳鼻咽喉科]