摘要
目的 探讨高分辨CT(HRCT)对外耳道胆脂瘤(external auditory canal cholesteatoma,EACC)术前分期及手术方式的指导价值。方法 选取手术治疗的93例(97耳)EACC患者,对其进行CT检查,根据颞骨高分辨CT检查EACC的侵犯范围、外耳道壁骨质受损情况以及颞骨HRCT结果将EACC分为三期。Ⅰ期患者仅行胆脂瘤清理,术中发现皮肤缺损较大者可行植皮。Ⅱ期无明显外耳道狭窄者可于耳内镜下行外耳道成形术,反之如果外耳道骨性狭窄明显则选择显微镜下耳内或耳后切口外耳道成形术。Ⅲ期患者根据病变范围及乳突气化程度进行手术方式选择,如果病变局限于鼓室,向后不超过水平半规管行单纯耳内镜手术;病变仅累及乳突且乳突气化好,选择完壁乳突根治术;如同时侵犯乳突鼓室且乳突气化好,可采用完壁乳突根治联合耳内镜的双镜联合入路手术方式;如侵犯乳突和(或)侵犯鼓室,但乳突气化欠佳,则行改良乳突根治术且最后进行外耳道成形同时缩窄术腔。将CT分期与术中所见结果进行对比。结果 患耳均表现为外耳道内低密度影,77耳存在不同程度的外耳道骨质破坏,其中下壁70耳、后壁62耳、前壁46耳、上壁37耳。97耳EACC病例中按CT分期Ⅰ期20耳(20.6%),Ⅱ期24耳(24.7%),Ⅲ期53耳(54.6%),其中Ⅲa期20耳(20.6%)、Ⅲb期7耳(7.2%)、Ⅲc期26耳(26.8%)。EACC CT分期与术中所见总符合率达91.8%(89/97)。术后随访6个月至2年,平均气骨导差较前减少(17.8±12.0)dB,差异有统计学意义(t=8.361,P<0.001)。结论 根据颞骨高分辨CT检查表现特征进行外耳道胆脂瘤分期,结果准确、可靠,有利于手术方式指导。
Objective To explore the value of high-resolution CT in preoperative staging and surgical planning for external auditory canal cholesteatoma(EACC).Methods 93 patients(97 ears)with EACC who underwent surgery were prospectively collected.EACC was classified into three stages according to the temporal bone high-resolution CT(HRCT)findings.StageⅠpatients were needed only cholesteatoma cleaning,and skin grafting was performed when large skin defects were found during the operation.StageⅡpatients without significant external auditory canal narrowing were subjected to canaloplasty with oticendoscope,otherwise,to postauricular canaloplasty with microscope.For StageⅢpatients,the choice of surgical approach depended on the extent of the lesions and the degree of mastoid aeration.Endoscopic surgery was chosen for lesions limited to the tympanic cavity and semicircular.Canal wall-up type radical mastoidectomy(CWUM)was conducted for lesions limited to the pneumatic mastoid,and combing CWUM and endoscopic procedures was performed for lesions involving both the mastoid and tympanic cavity.Modified radical mastoidectomy and external auditory canal reconstruction were performed in patients with poor mastoid aeration.Results All affected ears exhibited low-density shadows within the external auditory canal on CT imaging.Bony erosion of the external auditory canal was observed in 77 ears,involving the inferior wall in 70 ears,posterior wall in 62 ears,anterior wall in 46 ears,and superior wall in 37 ears.Among the 97 ears diagnosed with external auditory canal cholesteatoma(EACC),CT-based staging classified 20 ears(20.6%)as stageⅠ,24 ears(24.7%)as stageⅡ,and 53 ears(54.6%)as stageⅢ-including 20 ears(20.6%)as stageⅢa,7 ears(7.2%)as stageⅢb,and 26 ears(26.8%)as stageⅢc.The overall concordance rate between CT staging and intraoperative findings was 91.8%(89/97).During postoperative follow-up ranging from 6 months to 2 years,the average air-bone gap was significantly reduced by(17.8±12.0)dB(t=8.361,P<0.001).Conclusion This staging system is accurate and easily applicable for use when deciding the surgical modality for patients with EACC.
作者
钱旺
张清华
王晨华
高元会
王雅杰
李建峰
于淑东
何明强
陈成芳
李红
QIAN Wang;ZHANG Qinghua;WANG Chenhua;GAO Yuanhui;WANG Yajie;LI Jianfeng;YU Shudong;HE Mingqiang;CHEN Chengfang;LI Hong(Department of Otolaryngology,Shandong First Medical University Affiliated Provincial Hospital,Jinan 250021,China;Department of Radiology,Shandong First Medical University Affiliated Provincial Hospital,Jinan 250021,China)
出处
《医学影像学杂志》
2025年第7期14-17,31,共5页
Journal of Medical Imaging
关键词
外耳道胆脂瘤
分期
耳外科手术
体层摄影术
X线计算机
External auditory canal cholesteatoma
Classification
Otologic surgical procedures
Tomography,X-ray computed
