多层螺旋CT对中耳胆脂瘤鼓室壁破坏的诊断价值  

Diagnostic value of multi-slice spiral CT in tympanic wall destruction of middle ear cholesteatoma

作　　者：胡瑞利 张晓辰 耿鹤群[2] 李栋[1] 张青俊[1] 林彦涛[1] HU Ruili;ZHANG Xiaochen;GENG Hequn;LI Dong;ZHANG Qingjun;LIN Yantao(Department of Otolaryngology Head and Neak Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou,075000,China;Department of Medical Imaging,the First Affiliated Hospital of Hebei North University,Zhangjiakou,075000,China)

机构地区：[1]河北北方学院附属第一医院耳鼻咽喉头颈外科,河北张家口075000 [2]河北北方学院附属第一医院医学影像部,河北张家口075000

出　　处：《临床耳鼻咽喉头颈外科杂志》2021年第11期961-965,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：河北省卫健委青年科技课题(No:20200531)。

摘　　要：目的:探讨中耳胆脂瘤患者术前颞骨计算机断层扫描(CT)的表现与术中鼓室壁表现的相关性。方法:回顾性分析2017年3月—2020年11月手术治疗的胆脂瘤患者。比较患者术前颞骨CT所见鼓室壁状态与术中所见鼓室壁状态。结果:148例(148耳)患者纳入分析,对比CT表现与术中观察,142例经CT检查的鼓室盖与术中观察相同,144例CT显示乳突盖状态与术中所见相同。CT所见18例患者面神经管状态与术中所见不同。CT所见12例鼓室内侧壁破坏中,10例与术中所见一致。CT所见6例乙状窦破坏,其中5例与术中所见一致,CT所见142例乙状窦无破坏,其中1例与术中所见不同。HRCT所见鼓室壁中,对面神经管裸露诊断效能较差(Se=78.6%,Sp=90.0%,PPV=64.7%,NPV=94.7%,AUC=0.84,Kappa=0.63,P<0.05),对鼓室内侧壁破坏诊断效能较好(Se=83.5%,Sp=98.5%,PPV=83.3%,NPV=98.6%,AUC=0.91,Kappa=0.82,P<0.05)。结论:CT诊断中耳胆脂瘤鼓室壁破坏效能较好,特别是在检测鼓室盖、乳突盖、鼓室内侧壁及乙状窦的破坏方面。术前颞骨CT扫描对临床术前决策和术中引导是有益的。Objective: To investigate the correlation between preoperative temporal bone Computed Tomography(CT) findings and intraoperative manifestations in patients with middle ear cholesteatoma. Methods: The patients with cholesteatoma undergoing surgery in our hospital from March 2017 to November 2020 were retrospectively analyzed.The temporal bone CT findings of tympanoid wall status before operation and the state of tympanic wall during operation were compared. Results: A total of 148 cases(148 ears) were included in the analysis. Compared with intraoperative observation, 142 cases showed the same findings of tympanoid lid by preoperative CT examination, and 144 cases showed the same findings of mastoid lid by preoperative CT examination.The CT manifestations of facial nerve canal state in 18 patients was different from intraoperativen findings. Among the 12 cases of lateral wall destruction of the tympanic chamber observed by CT, 10 cases were consistent with the intraoperative findings.CT showed sigmoid sinus destruction in 6 cases, of which 5 cases were consistent with intraoperative findings. In 142 cases no sigmoid sinus destruction was found by CT, but in one case the CT findingswas different from intraoperative findings.The diagnostic efficiency of the exposed opposite neural tube was poor in the tympanoid wall observed by CT(Se=78.6%,Sp=90.0%,PPV=64.7%,NPV=94.7%,AUC=0.84,Kappa=0.63,P<0.05), but the diagnostic efficiency of lateral wall failure of the drum chamber was good(Se=83.5%,Sp=98.5%,PPV=83.3%,NPV=98.6%,AUC=0.91,Kappa=0.82,P<0.05). Conclusion: CT is effective in preoperative diagnosing of tympanic wall destruction caused by cholesteatoma of the middle ear, especially in detecting the destruction of tympanic lid, mastoid lid, lateral wall of the tympanic chamber and sigmoid sinus.Preoperative temporal bone CT scan is beneficial to clincal preoperative decision-making and intraoperative guidance.

关 键 词：胆脂瘤 鼓室壁 螺旋计算机断层摄影术 

分 类 号：R764.2[医药卫生—耳鼻咽喉科]