Vanden Abeele D, Offeciers F E
Department of Otorhinolaryngology, Head and Neck Surgery, M I St Augustinus, Antwerp University, Belgium.
Acta Otorhinolaryngol Belg. 1993;47(3):311-21.
Surgical management of labyrinthine fistulas caused by cholesteatoma remains controversial. In 213 patients with middle ear surgery for cholesteatoma, 18 patients (18 ears-8.5%) presented a labyrinthine fistula. These cases are reviewed in the present paper. Symptoms, audiometry, pre-operative imaging, surgical procedure and results are discussed. In all cases total removal of the pathology was pursued with preservation of cochlear function. A two-stage closed technique was used. During the first stage reconstruction with tympano-ossicular allografts, according to the technique of J. Marquet, was performed. A second look followed one year later. Three ears were deaf pre-operatively. Improvement of bone conduction was observed in more than 50% and hearing preservation in all other cases but one. In one ear total deafness occurred from extensive intralabyrinthine invasion by cholesteatoma, demanding a labyrinthectomy. The hearing was preserved in four cases in which an amputation of a large part of the membranous labyrinth could be observed. Since neither pre-operative clinical examination nor imaging can be relied on to reveal a fistula, the surgeon needs to be prepared for unexpected fistulas.
胆脂瘤引起的迷路瘘管的外科治疗仍存在争议。在213例行中耳胆脂瘤手术的患者中，18例（18耳，占8.5%）出现迷路瘘管。本文对这些病例进行了回顾。讨论了症状、听力测定、术前影像学检查、手术过程及结果。所有病例均在保留耳蜗功能的情况下彻底清除病变。采用两阶段封闭技术。第一阶段，根据J. Marquet的技术，用鼓室-听骨异体移植物进行重建。一年后进行二次探查。术前有3耳失聪。超过50%的病例骨传导得到改善，除1例以外的所有其他病例听力均得以保留。1耳因胆脂瘤广泛侵入迷路导致全聋，需行迷路切除术。4例可见大部分膜迷路被切除，但听力得以保留。由于术前临床检查和影像学检查均无法可靠地发现瘘管，外科医生需要为意外出现的瘘管做好准备。
