紧张部内陷袋性胆脂瘤的临床特点及手术疗效

Clinical Characteristics and Surgical Effects of Acquired Primary Pars Tensa Cholesteatoma

韩宇;张昌明;凤亚妮;郭璇;陈阳;查定军;邱建华;

1:空军军医大学(第四军医大学)西京医院耳鼻咽喉头颈外科

摘要

目的分析后天原发性紧张部内陷袋性胆脂瘤的分期、临床特点以及手术疗效。方法回顾性分析33例(33耳)经手术证实为紧张部内陷袋性胆脂瘤患者的临床资料,对患者术前鼓膜形态、胆脂瘤分期(2017 EAONO/JOS版)、病变侵及范围、听骨链受累情况、手术方式和听骨链重建方法以及术后并发症进行分析,比较手术前后患者的平均气导听阈、骨导听阈及气骨导差。结果 33例患者中,17例表现为鼓膜紧张部后上方内陷袋形成,10例为鼓膜紧张部后上方内陷伴穿孔,6例为整个鼓膜紧张部内陷伴或不伴穿孔。胆脂瘤分期为Ⅰ期4例,Ⅱ期29例;病变累及鼓室腔33例,鼓室窦26例,上鼓室11例,鼓窦乳突区6例,砧骨受累29例,镫骨受累16例。16例行鼓室成形术,15例行上鼓室切开重建+鼓室成形术,2例行开放式乳突切开+鼓室成形术;行听骨链重建者32例,其中选择部分听骨赝复体(partial ossicular replacement prosthesis,PORP)7例,全听骨赝复体(total ossicular replacement prothesis,TORP)5例,自体砧骨搭桥3例,软骨加高镫骨10例,皮质骨小柱7例。患者术后平均随访12.7个月,术后鼓膜紧张部穿孔2例,胆脂瘤残留或复发1例。术后气导听阈(43.2±14.0 dB HL)较术前(50.1±11.4 dB HL)显著降低(P<0.05),术后气骨导差(25.8±11.3 dB)较术前(33.1±9.3 dB)显著缩小(P<0.05),而手术前后骨导听阈差异无统计学意义(P>0.05)。结论紧张部内陷袋性胆脂瘤多源于紧张部后上方内陷袋,易侵犯砧骨和镫骨,听力下降出现早且较重;多数病变未超出中鼓室和上鼓室,可以经耳道完成胆脂瘤切除,选择合适的听骨链重建方法可提高患者听力。

关键词

紧张部;胆脂瘤;手术方式;听力重建

基金项目(Foundation):

国家自然科学基金(81870719);; 陕西省基金社会发展领域(2018SF-240)资助

作者

韩宇;张昌明;凤亚妮;郭璇;陈阳;查定军;邱建华;

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