先天性中耳胆脂瘤12例临床分析

Clinical Analysis of 12 Cases of the Congenital Middle Ear Cholesteatoma

戴炳译;关兵;于爱民;严齐;王茂华;

1:江苏省苏北人民医院耳鼻咽喉-头颈外科

2:扬州大学医学院

3:中南大学湘雅二医院耳鼻咽喉科

摘要
目的探讨先天性中耳胆脂瘤的诊断方法及手术方式。方法回顾性分析2008年1月2016年7月在苏北人民医院耳鼻咽喉-头颈外科诊治的12例单侧先天性中耳胆脂瘤患者的临床资料,探讨先天性中耳胆脂瘤的临床特点、诊断和手术方法。结果 12例先天性中耳胆脂瘤患者均符合Levenson诊断标准,其中2例伴耳鸣,1例伴耳后肿物,1例伴面瘫;12例术前0.5、1、2kHz平均听阈为55±4.2dB HL,平均气骨导差为45±3.7dB;术前颞骨高分辨率CT(HRCT)示8例胆脂瘤位于中后鼓室,主要是在砧镫关节处,2例位于中上鼓室,2例病变广泛侵及上鼓室及鼓窦。所有患者经手术治疗,6例经耳内径路鼓室探查清除胆脂瘤后行鼓室成形术,2例行完璧式乳突根治+鼓室成形术,4例行开放式乳突根治+鼓室成形术;其中1例伴面瘫患者病变累及面神经管壁,面神经受损,术中行面神经端端吻合术。术后6个月12例患者0.5、1、2kHz 6个月平均听阈35±6.3dB HL,平均气骨导差20±2.5dB。术后1年所有病例复查HRCT,未见胆脂瘤残留或复发。术后16个月时伴面瘫患者面神经功能由术前的Ⅲ级恢复至Ⅱ级。结论先天性中耳胆脂瘤临床少见,主要表现为传导性聋,HRCT为首选辅助检查,手术是唯一有效治疗方式,根据病变范围选择合适的手术方式,预后较好。
关键词
先天性胆脂瘤;高分辨率CT;手术
基金项目(Foundation):
作者
戴炳译;关兵;于爱民;严齐;王茂华;
参考文献

1 Bennett M,Warrea F,Jackson GC,et al.Congenital cholesteatoma theories,facts,and 53patients[J].Otolaryngol Clinical North Am,2006,39:1081.

2 Levenson MJ,Michaels L,Parisier SC.Congenital cholesteatomas of the middle ear in children:origin and management[J].Otolaryngol Clin North Am,1989,22:941.

3 Lim HW,Yoon TH,Kang WS.Congenital cholesteatoma:clinical features and growth patterns[J].Am J Otolaryngol,2012,33:538.

4 Malhotra V,Dayashankara RJ,Arya V,et al.Assessment of facial nerve injury with"House and Brackmann facial nerve grading system"in patients of temporomandibular joint ankylosis operated using deep subfascial approach[J].Natl J Maxillofac Surg,2015,6:194.

5 黄建民,易自翔,林国经,等.鼓室表皮样结构角蛋白表达的变异[J].中华耳鼻咽喉科杂志,1996,31:9.

6 Hidaka H,Yamaguchi T,Miyazaki H,et al.Congenital cholesteatoma is predominantly found in the posterior-superior quadrant in the Asian population:systematic review and meta-analysis,including our clinical experience[J].Otol Neurotol,2013,34:630.

7 申卫东,韩维举,杨仕明,等.先天性中耳胆脂瘤[J].中国听力语言康复科学杂志,2007(1):27.

8 Smouha EE,Javidfar J.Cholesteatoma in the normal hearing ear[J].Laryngoscope,2007,117:854.

9 辛鑫,卢伟,孙淑萍,等.10例先天性中耳胆脂瘤临床分析[J].临床耳鼻咽喉头颈外科杂志,2014,28:443.

10 Kim SH,Cho YS,Chu HS,et al.Open-type congenital cholesteatoma:differential diagnosis for conductive hearing loss with a normal tympanic membrane[J].Acta Otolaryngol,2012,132:618.

11 中华医学会耳鼻咽喉头颈外科学分会耳科学组,中华耳鼻咽喉头颈外科杂志编辑委员会耳科组.中耳炎临床分类和手术分型指南[2012][J].中华耳鼻咽喉头颈外科杂志,2013,48:5.

12 龚桃根,柯朝阳.先天性中耳胆脂瘤的临床诊断与治疗进展[J].中华耳科学杂志,2016,14:427.

13 Bennett M,Warren F,Jackson GC,et al.Congenital cholesteatoma:theories,facts,and 53patients[J].Otolaryngol Clin North Am,2006,39:1081.

14 Shirazi MA,Muzaffar K,Leonetti JP,et al.Surgical treatment of pediatric cholesteatomas[J].Laryngoscope,2006,116:1603.

15 James AL.Endoscopic middle ear surgery in children[J].Otolaryngol Clin North Am,2013,46:233.

16 James AL,Papsin BC.Some considerations in congenital cholesteatoma[J].Curr Opin Otolaryngol Head Neck Surg,2013,21:431.

17 Marchioni D,Villari D,Mattioli F,et al.Endoscopic management of attic cholesteatoma:a single-institution experience[J].Otolaryngol Clin North Am,2013,46:201.

本文信息

PDF(389K)

本文关键词相关文章

先天性胆脂瘤高分辨率CT手术