摘要
目的探讨外耳道胆脂瘤的临床特点及诊治方法。方法回顾性分析武汉大学人民医院耳鼻咽喉-头颈外科2000～2005年收治的49例外耳道胆脂瘤患者的临床资料。结果术前所有患者外耳道均见灰白色或黄白色软组织充填，外耳道皮肤可见慢性炎症。所有病例病变以外耳道为中心，外耳道均有不同程度的侵蚀扩大；其中8例患者病变向远深部扩展侵犯乳突和或鼓膜、上鼓室；2例面神经垂直段骨质破坏。根据病变范围，10例患者商接在手术显微镜下彻底清除病变；31例患者行耳内切口显微镜下彻底清除病变，术中见鼓膜紧张部穿孔5例．术后均行Ⅱ期鼓膜修补术；4例患者行乳突根治术，术中见鼓膜缺如，听骨链残缺；4例患者行改良乳突根治术，术中见听骨链完整．2例松弛部穿孔，术后行Ⅱ期鼓室成型术。术前45例（91.8％）患者为传导性聋，言语频率平均气导听阈为19．3±9．1dBHL；4例（8．2％）为混合性聋，言语频率平均气导听阈为65．2±10．7dBHL，平均骨导听蝴为50.5±11.3dB HL。除4例行乳突根治术的患者以外，其余患者术后气导听阈均有较大提高，言语频率平均气导听阈提高15～23dB。随访18个月～6年未见复发。结论外耳道胆脂瘤可以造成广泛破坏，术前颞骨薄层CT扫描对诊断有较大帮助。其治疗应根据病变范围、局部感染与否选择合适术式尽早彻底清除病灶。术后患者气导听力多有较大提高。
Objective To study the clinical characteristics, diagnosis and treatment of cholesteatoma associated with the external acoustic meatus. Methods Forty nine cases of external acoustic meatus chotesteatoma were reviewed. Results All the cases presemed with skin chronic infection and bone erosion in the walls of the external auditory canal with a degree from mild to severe. In some cases the disease infected the mastoid . The bony mastoid segment of facial canal was destroyed in 2 cases. According to the extent of disease, all the cases were treated with complete removal of the chotesteatoma, degenerated tissue, sequestrum and the application of antibiotics. All the cases were followed up from 18 month to 6 years, and no recurrent cases were found. The hearing loss of most cases was improved to a certain extent. Conclusion High resolution temporal bone CT scan can help identify the prima ry lesion and determine the range of the pathological changes, and choose the best surgical approach. The hearing loss will be improved in most cases.
出处
《听力学及言语疾病杂志》
CAS
CSCD
2008年第4期301-303,共3页
Journal of Audiology and Speech Pathology
关键词
外耳道
胆脂瘤
诊断
治疗
External acoustic meatus
Cholesteatoma
Diagnosis
Treatment
