内镜辅助下岩骨胆脂瘤手术治疗方法及优势分析  

Methods and advantages of endoscope-assisted petrous bone cholesteatoma surgery

作　　者：朱玉华[1,2] 朱荔 王方园 贾建平[1] 杨淑芝[1] 赵丹珩[1] 王辉兵 刘娅[1] 刁明芳 侯昭晖 ZHU Yuhua;ZHU Li;WANG Fangyuan;JIA Jianping;YANG Shuzhi;ZHAO Danheng;WANG Huibing;LIU Ya;DIAO Mingfang;HOU Zhaohui(Department of Otorhinolaryngology Head and Neck Surgery,Chinese People’s Libration Army General Hospital,Beijing 100048,China;Department of Otolaryngology Head and Neck Surgery,Hainan Hospital of People's Libration Army General Hospital,Sanya 572013,China)

机构地区：[1]中国人民解放军总医院耳鼻咽喉头颈外科医学部耳内镜外科,北京100037 [2]中国人民解放军总医院海南医院耳鼻咽喉头颈外科,三亚572013

出　　处：《中国眼耳鼻喉科杂志》2023年第3期232-237,共6页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：海南省自然科学基金(820QN381)。

摘　　要：目的探讨内镜辅助下治疗岩骨胆脂瘤的方法和技术特点,分析功能保全优势。方法回顾分析中国人民解放军总医院耳内镜外科2020年6月~2022年6月手术治疗的6例颞骨岩部胆脂瘤病例的临床资料。按Sanna方法分型:迷路上型2例、岩尖型1例、广泛型3例。所有患者均完整切除岩骨胆脂瘤。其中耳内镜辅助手术治疗者3例,均为广泛型,均为耳后入路,包括经耳囊入路2例(20.0%)和经迷路入路1例(16.0%)。结果内镜辅助下治疗的患者占所有岩骨胆脂瘤患者的50%,术中入路主要为内镜辅助内听道上经迷路入路和内镜辅助经迷路下入路。所有患者均未行面神经移位,完整清除岩尖部、面神经周围、颈内动脉、颈静脉球、内听道及硬脑膜周围胆脂瘤。术前面神经功能正常者术后也正常,术前面瘫患者经减压后面神经功能恢复正常1例。手术术腔封闭3例,无术后复发病例。结论内镜辅助下进行岩骨胆脂瘤的手术入路多样,根据病灶部位联合应用多种入路,具有复发率低、可保全血管、神经功能等优势。Objective To explore the surgical strategy of endoscope-assisted petrous bone cholesteatoma,and to summarize the technical characteristics and functional preservation advantages.Methods The clinical manifestations,imaging examinations,surgical methods and surgical outcomes of 6 cases with petrous bone cholesteatoma treated in the Department of Endoscopic Otologic Surgery,Chinese PLA General Hospital from June 2020 to June 2022 were retrospectively analyzed.According to Sanna’s classification,there were two cases of supralabyringeal type,1 case of petrous apex type,and three cases of extensive type.All patients underwent surgical treatment with a complete resection of petrous bone cholesteatoma.A total of three cases were selected for endoscopic-assisted the operation,all of which were extensive type,and the surgical approach was retroauricularly,including two cases(20.0%)through transostic approach and one case(16.0%)through labyrinthian approach.Results The majority of patients with petrous bone cholesteatoma were treated with endoscopy.The main endoscope-assisted approaches were supra-internal auditory canal labyrinthiasis approach and endoscope-assisted infra-labyrinthiasis approach.All patients did not receive facial nerve transfer.The patients with normal facial nerve function before operation had normal facial nerve function after operation.The nerve function of one patient with preoperative facial paralysis recovered to normal after decompression.Three patients underwent surgical cavity closure.No postoperative recurrence occured.Conclusions There are various surgical approaches for endoscope-assisted petrous bone cholesteatoma.The lesions can be removed according to the need,and multiple approaches can be used in combination during the operation,which has many advantages such as reducing the recurrence of lesions and improving the vascular and nerve preservation rate.

关 键 词：胆脂瘤 颞骨岩部 内镜辅助 手术方法 优势 

分 类 号：R764.8[医药卫生—耳鼻咽喉科] R764.92[医药卫生—临床医学]