摘要
目的:探讨治疗外耳道胆脂瘤的手术方法,评价其疗效。方法:累及鼓室、乳突的外耳道胆脂瘤患者42例45耳,均行外耳道胆脂瘤切除、外耳道成形及耳甲腔成形术,其中3耳行Ⅱ型鼓室成形术,4耳行完壁式乳突根治术,5耳行开放式乳突根治术,3耳行外耳道后壁重建术,21耳行Ⅰ型鼓室成形术。术后3、6、12个月行纯音测听检查,随后要求每年门诊复诊,观察术腔及听力情况。结果:2耳分别于术后2、3个月出现外耳道瘢痕狭窄,2耳术后1年局部复发,1耳术后反复流水不干耳,7个月后行二次手术,其余患者术腔上皮化良好,鼓膜完整。所有患者听力均有不同程度提高,平均气导听力提高5～30dB HL。结论:侵及鼓室、乳突的外耳道胆脂瘤应根据病变破坏范围采取不同的手术方式;鼓室成形、完壁式或开放式乳突根治、外耳道后壁重建、外耳道成形、耳甲腔成形、耳道植皮对建立通畅引流、防止外耳道狭窄、预防胆脂瘤复发、提高听力有较好的疗效。
Objective：To explore the operation treatments and their outcomes of external auditory canal cholesteatomas involving the tympanic cavity and mastoid process.Method：Forty-two patients（45 ears）with external auditory canal cholesteatomas were included in this study who were operated.All lesions invaded the tympanic cavity and mastoid process.Excision of cholesteatoma,external auditory canal angioplasty and concha formation were performed.Ossicular chain reconstruction was performed in 3 ears.Mastoidectomy with close technique were performed in 4 ears.Open radical mastoidectomy was performed in 5 ears.Posterior bone-wall of auricular meatus reconstruction was performed in 3 ears.Tympanoplasty was performed in 21 ears.Pure tone audiogram and aural endoscope were carried out after the operation（3 months,6 months,1 year,2 years,3 years…）.Result：Stricture of external auditory meatus were occured in 2 ears in 2 and 3 months after surgery respectively.Cholesteatoma recurrence was observed in 2 ears in 1 year after operation.Wet ear was observed in 1 patient and then another operation was performed after 7 months.Besides the patients above,the epitheliums of the cavity were well in all other patients with complete tympanic membranes.Hearing was improved in all patients（hearing by air conduction：5-30 dB HL）.Conclusion：According to the range of the external auditory canal cholesteatoma,we took different operation methods including tympanoplasty,open or close radical mastoidectomy and reconstruction of posterior wall of external auditory canal etc.Those methods,including external auditory canal angioplasty,cavity plasty of concha and skin grafting of external auditory canal,could help to prevent scar formation and stricture of external auditory canal,prevent cholesteatoma recurrence and improve hearing.
作者
宋忠义
于学民
王春芳
王宁
傅莹
孙永强
SONG Zhongyi;YU Xuemin;WANG Chunfang;WANG Ning;FU Ying;SUN Yongqiang(Department of Otolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University,Qing- dao, 266035, Chin)
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
北大核心
2018年第12期937-940,共4页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
胆脂瘤
鼓室
乳突
外耳道成形
外耳道后壁重建
cholesteatoma
tympanum
mastoid
external auricular formation
reconstruction of the external canal
