耳内镜下经外耳道处理不同分期外耳道胆脂瘤  

Endoscopic treatment of cholesteatoma of external auditory canal in different stages

作　　者：吴艳红 范相民 Wu Yanhong;Fan Xiangmin(Department of Otorhinolaryngology,Dongda Hospital,Heze 274300,China)

机构地区：[1]单县东大医院耳鼻咽喉科,菏泽274300

出　　处：《国际耳鼻咽喉头颈外科杂志》2023年第6期320-323,共4页International Journal of Otolaryngology-Head and Neck Surgery

摘　　要：目的 探讨耳内镜下经外耳道处理不同分期外耳道胆脂瘤的手术方法及术后效果.方法 对2016年5月至2019年7月单县东大医院收治的76例外耳道胆脂瘤患者临床资料进行回顾性分析,根据Udayabhanu重新分期,Ⅰ期26例,Ⅱ期38例,ⅢA期12例,Ⅰ期、Ⅱ期(仅外耳道骨质破坏)行外耳道胆脂瘤摘除术,Ⅱ期侵及鼓膜者实施鼓室成形术,侵及鼓室实施鼓室成形术+人工听骨植入+外耳道重建,ⅢA期实施乳突开放、鼓室成形及外耳道重建,对患者随访12个月,观察各组手术效果.结果 患者总有效率为94.74%(72/76),Ⅰ期、Ⅱ期、ⅢA期患者术后平均纯音听阈(PTA)及气骨导差(air bone conduction difference,ABG)值均较术前低,差异均有统计学意义(P均<0.05).患者术后出现外耳道膜性闭锁1例,外耳道狭窄1例,经对症处理后均改善,随访期间患者未复发,耳鸣、耳痛、耳漏等症状基本消失或显著改善.结论 耳内镜下不同分期外耳道胆脂瘤手术效果理想,患者术后听力水平可显著提高,并发症较少.Objective To explore the surgical methods for different stages of external auditory canal cholesteatoma through the external auditory canal under otoendoscope and their postoperative effects.Methods The clinical data of 76 patients with cholesteatoma of the ear canal admitted to Dongda Hospital from May 2016 to July 2019 were retrospectively analyzed.According to Udayabhanu,26 cases of stage I,38 cases of stage II,and 12 cases of stage IIIA were reclassified according to Udayabhanu.In stage I and II(only bone destruction of the external auditory canal was found),the cholesteatoma will be removed when it's restricted in the external canal,and when the tympanic membrane was invaded,tympanoplasty was conducted,and when the tympanic cavity was invaded,tympanoplasty+artificial ossicular implantation+external auditory canal reconstruction were performed.In stage IIIA,mastoidectomy,tympanoplasty and external auditory canal reconstruction were performed.The patients were followed up for 12 months to observe the surgical effects of each group.Results The total effective rate of 76 patients was 94.74%(72/76);the postoperative PTA and ABG in patients of stage I,stage II,and stage IIIA were lower than those before operation(P<0.05);There was 1 case of external auditory canal membranous atresia and 1 case of external auditory canal stenosis were found after the operation and both were improved after symptomatic treatment.During follow-up,no recurrence was found,and symptoms such as tinnitus,earache,and otorrhea basically disappeared or improved significantly.Conclusions Surgery for different stages of external auditory canal cholesteatoma under otoendoscope has ideal results,the patient's hearing level can be significantly improved after surgery,and there are fewer complications.

关 键 词：耳外科手术 预后 耳内镜 外耳道胆脂瘤 分期 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]