[外耳道广泛性胆脂瘤的临床特征及外科治疗]

[Clinical characteristics and surgical management of extensive cholesteatoma of external auditory canal].

作者信息

Wang Huibing, Yu Fei, Shan Xizheng, Zhang Feng, Long Shunbo, Gao Yun, Zhao Longzhu, Han Dongyi

机构信息

Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Otorhinolaryngology, PLA General Hospital, Beijing,100853, China.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013 May;27(10):468-72.

PMID:23937009

Abstract

OBJECTIVE

To classify the external auditory canal cholesteatoma(EACC) by high-resolution temporal bone CT scans and the clinical findings of the patients, and to discuss the clinical and imaging characteristics and the surgical management of the extensive EACC.

METHOD

A retrospective study was carried out among 56 patients (58 ears) with EACC and their clinical data were carefully analyzed. We classified EACC as the extensive type and the localized type. The operation strategy depended on the extent of lesion. All cases were followed up for 1 to 6 years after surgery.

RESULT

There were 31 patients with localized EACC, 2 with no bone erosion and 29 (31 ears) with bone erosion within external auditory canal, and 25 patients with extensive EACC, 16 with bone erosion of intra temporal bone and 9 with bone erosion of extra temporal bone. Among all the 25 patients with the extensive type, the most common symptoms were otorrhea, otalgia and hearing loss, with 25, 23, 22 cases, respectively. The tympanic membrane (TM) was intact in 23 patients and perforated in two. The mastoid air cells in 23 patients were involved by the lesion, as well as tympanic antrum in eight, tympanic cavity in two, sigmoid sinus bony wall in five, mastoid segment of facial canal in four, and temporomandibular joint in two patients. Twenty patients underwent modified radical mastoidectomy, only one underwent reconstruction of ossicular chain, and four underwent canaloplasty. The average time of ear dry after surgery was 29 days. The postoperative hearing was improved by an average of 15 dB. No recurrence except for one patient was found during the follow-up period.

CONCLUSION

It was of important clinical significance to classify EACC as the extensive type and the localized type. The extensive EACC was misdiagnosed easily because of the complicated clinical manifestations. The classification was helpful for the diagnosis and the selection of surgery strategy of EACC.

摘要

目的

通过高分辨率颞骨CT扫描及患者临床症状对外耳道胆脂瘤（EACC）进行分型，探讨广泛型外耳道胆脂瘤的临床及影像学特征和手术治疗方法。

方法

对56例（58耳）外耳道胆脂瘤患者进行回顾性研究，仔细分析其临床资料。将外耳道胆脂瘤分为广泛型和局限型。手术策略取决于病变范围。所有病例术后随访1至6年。

结果

局限型外耳道胆脂瘤患者31例，其中2例无骨质侵蚀，29例（31耳）外耳道骨质有侵蚀；广泛型外耳道胆脂瘤患者25例，其中16例颞骨内骨质有侵蚀，9例颞骨外骨质有侵蚀。在所有25例广泛型患者中，最常见的症状是耳漏、耳痛和听力下降，分别有25例、23例和22例。23例患者鼓膜完整，2例鼓膜穿孔。23例患者的乳突气房受病变累及，8例鼓窦受累，2例鼓室受累，5例乙状窦骨壁受累，4例面神经管乳突段受累，2例颞下颌关节受累。20例患者行改良乳突根治术，仅1例行听骨链重建，4例行外耳道成形术。术后平均干耳时间为29天。术后听力平均提高15 dB。随访期间除1例患者外未发现复发。