乳突型先天性胆脂瘤伴外伤后巨大血肿1例  

A case of mastoid congenital cholesteatoma with posttraumatic giant hematoma

作　　者：郭瑞康 叶惠平 GUO Ruikang;YE Huiping(Clinical Medical College,Guizhou Medical University,Guiyang,Guizhou 550000,China)

机构地区：[1]贵州医科大学临床医学院,贵州贵阳550000

出　　处：《安徽医药》2023年第6期1166-1169,I0007,共5页Anhui Medical and Pharmaceutical Journal

基　　金：贵州省科学技术基金(黔科合基础-ZK[2021]一般426)。

摘　　要：目的 提高临床医生对乳突型先天性胆脂瘤并外伤后巨大血肿病人的认识及诊断、治疗水平。方法 因“左耳后撞伤肿胀疼痛9个月,加重4天”1例于2021年2月9日入贵州医科大学附属医院,其临床表现及影像学资料缺乏特异性,极易误诊,病人于2021年2月10日全麻显微镜下行左侧完壁式乳突根治术+乳突占位切除术。结果 彻底切除肿物并清除血肿,术后病理及免疫组化证实乳突占位中央为纤维素及炎细胞渗出凝块,乳突占位边缘为炎性肉芽组织伴异物肉芽肿形成,符合胆脂瘤改变。术后6个月随访,病人无耳痛、耳流脓、耳后肿胀、听力下降、眩晕等症状,复查耳内镜、颞骨CT未见复发及进展征象,复查纯音听阈示左耳听力基本恢复正常。结论 该病人有外伤史,术中证实颞骨胆脂瘤并巨大血肿形成,较为罕见,诊断依靠病理学检查,治疗以手术彻底切除为主,术后需密切随访。Objective To improve clinicians'understanding,diagnosis and treatment of patients with congenital cholesteatoma of the mastoid type and posttraumatic giant hematoma.Methods The patient was admitted to the Affiliated Hospital of Guizhou Medical University on February 9,2021,with a cause of"painful swelling behind the left ear for 9 months,aggravated for 4 days".The clinical manifestations and imaging data lacked specificity and were easily misdiagnosed.The patient underwent radical mastectomy of the left intact mastoid+mastoid occupancy on February 10,2021 under general anesthesia and microscopy.Results The swelling of the patient was completely removed and the hematoma was cleared.Postoperative pathology and immunohistochemistry confirmed a central mastoid mass with fibrin and inflammatory cell exudate clots and a mastoid mass with inflammatory granulation tissue with foreign body granuloma formation at the edge,consistent with cholesteatoma changes.The patient had no symptoms,such as ear pain,ear pus,postauricular swelling,hearing loss,or vertigo,at the 6-month postoperative follow-up.Furthermore,no signs of recurrence or progression were seen in the endoscopic examination and temporal bone CT,and the reexamination of the pure tone hearing threshold showed that the hearing in the left ear was basically normal.Conclusion The patient had a history of trauma,and intraoperative confirmation of temporal bone cholesteatoma with large hematoma formation was rare.Diagnosis relies on pathological examination,and treatment is based on complete surgical resection,with close postoperative follow-up needed.

关 键 词：胆脂瘤 中耳 颞骨 乳突 创伤和损伤 血肿 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]