摘要
目的分析外耳道胆脂瘤(EACC)修订手术病例的临床特点、处理及预后。方法回顾性分析2011-2019年EACC术后因外耳道狭窄、闭锁伴外耳道胆脂瘤复发10例(8名患者)于我院行修订手术的临床特征、修订手术要点。结果10例修订手术中,5例为外耳道狭窄,5例为外耳道闭锁。3例术中发现外耳道骨质增生。修订手术与前次手术间隔0.5年~20年,平均5.3年±5.9年。行修订式手术前诊断:3例为单纯EACC,7例为EACC侵犯中耳。单纯EACC 3例均行胆脂瘤清理术,其中1例行耳甲腔成形术,2例行外耳道骨性扩大术。侵犯中耳7例中有3例行开放式乳突根治术,其他为单纯鼓室探查或完壁式鼓室成形术,但均在术中磨宽骨性外耳道。术中2例行自体皮移植术,1例植入脱细胞异体真皮,其他未植皮。术后再随访时间3个月~9年,平均2.8±2.9年。再随访病例中4例(2人)出现再次粘连闭锁,其中1例门诊处理后恢复可;其他6例(6人)随访期内无狭窄或闭锁。所有病例在最后一次手术后随访期内均未见胆脂瘤复发。我院2011-2019年诊断为EACC并手术病例总数为230例。上述10例病例中,5例由外院完成首次手术。故我院EACC手术再手术率为2.17%(5例/230例)。结论EACC术后有一定的再狭窄率,EACC广泛破坏外耳道皮肤,甚至环周皮肤缺损,是再狭窄的可能原因。年轻患者组织生长旺盛,较年老患者更易发生再狭窄。皮肤损失严重病例,进行适当的植皮十分必要,可能会减少再狭窄的发生。
Objective To report clinical characteristics,management and prognosis of external auditory canal cholesteatoma(EACC).Method Ten cases of revision surgeries(8 patients)for external auditory canal stenosis or atresia with recurrent external auditory canal cholesteatoma after EACC surgery from 2011 to 2019 at our hospital were retrospectively analyzed for clinical characteristics and key surgical points.Results Findings included external auditory canal stenosis(5 cases)and atresia(5 cases),as well as osseous external auditory canal hyperplasia(3 cases).The interval between revision and initial surgeries was 0.5 to 20 years(average 5.3±5.9 years).Invasion of the middle ear was diagnosed before revision surgery in 7 cases.Simple EACC cholesteatoma resection was needed in 3 cases with concurrent conchoplasty in 1 case and enlargement of osseous external auditory canal in 2 cases.In the rest 7 cases,procedures included open radical mastoidectomy(3 cases)and exploratory tympanotomy or canal wall up tympanoplasty with osseous external auditory canal enlargement(4 cases).In the 10 cases,autologous skin graft(2 cases)or acellular allogeneic dermis graft(1 case)were used for skin repair.During the 3 months to 9 years follow-up(average 2.8±2.9 years),re-adhesion and atresia occurred in 4 cases(2 patients),which resolved after treatment in office in 1 case.No recurrence of cholesteatoma was found during follow-up after the last revision operation.EACC was diagnosed and operated on in 230 cases at our hospital from 2011 to 2019.Of the 10 cases reported,5 had the initial surgery in other hospitals.The rate of revision in EACC at our hospital was 2.17%(5/230).Conclusion Restenosis may occur after EACC surgery.The possible cause is extensive destruction(especially when circumferential)of external auditory canal skin by EACC,.Restenosis is more likely to happen in younger patients compared to older patients.In cases with extensive skin loss,skin grafting is necessary and may reduce the incidence of restenosis.
作者
宋昱
王宇
鲁兆毅
张绍兴
黄宇童
马芙蓉
潘滔
SONG Yu;WANG Yu;LU Zhaoyi;ZHANG Shaoxing;HUANG Yutong;MA Furong;PAN Tao(Department of Otolaryngology,Peking University Third Hospital,Beijing,100191)
出处
《中华耳科学杂志》
CSCD
北大核心
2021年第2期383-386,共4页
Chinese Journal of Otology
基金
北京大学深圳研究院科研项目支持,项目编号:A68489-02。
关键词
外耳道胆脂瘤
狭窄
修订手术
植皮
External auditory canal cholesteatoma
Stenosis,Revision surgery
Skin grafting
