全耳内镜下岩部胆脂瘤手术疗效分析  

Outcomes of ear endoscopic surgery for petrous bone cholesteatoma

作　　者：李波[1] 郑永波[1] 周鹏[1] 邓迪[1] 赵宇[1] Li Bo;Zheng Yongbo;Zhou Peng;Deng Di;Zhao Yu(Department of Otorhinolaryngology-Head&Neck Surgery,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院耳鼻咽喉头颈外科,成都610041

出　　处：《中华医学杂志》2025年第14期1116-1119,共4页National Medical Journal of China

基　　金：四川省自然科学基金项目(2023NSFSC0535)。

摘　　要：探讨全耳内镜下岩部胆脂瘤(PBC)手术策略及疗效。回顾性分析2017年1月至2024年1月于四川大学华西医院行全耳内镜下PBC手术治疗且随访时间≥1年的PBC患者临床资料,分析PBC病变特点、手术资料及预后情况。最终纳入7例患者,男4例,女3例,年龄28~59(36.4±11.0)岁。根据Sanna分型,迷路上型4例,广泛型3例,均采用耳内镜下切除手术。所有患者术中未行面神经移位,比较术前及术后面神经功能House-Brackman(HB)分级,5例患者术后面神经功能保存;1例术前Ⅳ级,术后Ⅴ级;1例术前Ⅵ级,术后仍为Ⅵ级。4例患者术前为重度传导性聋或混合性聋,术中保留迷路,给予一期人工听骨听力重建,术后听力提高;3例患者术前为极重度感音神经性耳聋,术中切除迷路,未行听力重建。2例患者术后出现脑脊液耳漏,出院前消失。所有患者于术后2个月内干耳,1例患者术后1年复发。研究结果提示全耳内镜下PBC手术可行,且有助于减小创伤和复发。This study aimed to explore the surgical strategies and outcomes of petrosal bone cholesteatoma(PBC)surgery under ear endoscope.A retrospective analysis was conducted on the clinical data of PBC patients who underwent endoscopic surgery for PBC and were followed-up for≥1 year at West China Hospital,Sichuan University,from January 2017 to January 2024.The characteristics of the lesions,surgical procedures,and prognoses were evaluated.A total of seven patients were included,consisting of four males and three females,with 28-59(36.4±11.0)years.According to the Sanna classification,four cases were classified as supralabyrinthine type and three as massive type,and all were managed with endoscopic resection.No facial nerve transposition was performed in any patient during surgery.Comparison of preoperative and postoperative facial nerve function based on the House-Brackman(HB)grading system showed that facial nerve function was preserved in five patients postoperatively;one patient was gradeⅣpreoperatively and gradeⅤpostoperatively,and one patient was gradeⅥpreoperatively and remained gradeⅥpostoperatively.Four patients had severe conductive or mixed hearing loss preoperatively,with the labyrinth preserved during surgery and one-stage ossicular reconstruction for hearing improvement;three patients had extreme sensorineural hearing loss preoperatively,with the labyrinth resected during surgery and no hearing reconstruction performed.Two patients experienced transient and minor cerebrospinal fluid otorrhea,which was resolved before discharge.All patients had dry ears within two months postoperatively,with one case of recurrence diagnosed at an external institution one year postoperatively.The endoscopic approach is feasible and appears beneficial in reducing trauma and recurrence rates in PBC surgery.

关 键 词：胆脂瘤 颞骨岩部 耳内镜 手术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]