摘要
目的:报告易漏诊先天性胆脂瘤患者的临床症状、影像学特点及手术治疗。方法:回顾分析2016-01-2018-05期间诊治的20例先天性胆脂瘤患者的临床资料,包括发病年龄、临床症状、体征、听力学、颞骨CT、手术方式等。结果:20例先天性胆脂瘤患者,临床均表现有患耳听力下降,其中伴耳闷胀感5例,耳鸣4例。鼓膜局部黄白色影13例,鼓膜正常5例,鼓膜膨隆2例;纯音测听符合传导性聋14例,混合性聋6例。颞骨CT示病变侧乳突呈气化型15例,板障型4例,硬化型1例。病变呈孤立散在的絮状影15例,呈团块状影5例。病变局限于上鼓室6例,局限于鼓室4例,位于鼓室、上鼓室3例,位于乳突及鼓窦2例,位于乳突、鼓窦及鼓室1例,位于鼓窦、鼓室及岩尖1例,位于鼓室、下鼓室、后鼓室及咽鼓管鼓口1例,位于鼓窦入口、上鼓室及后鼓室1例,位于鼓室、上鼓室、后鼓室1例。行完壁式乳突切开、鼓室成形术7例,行开放式乳突切开、鼓室成形术5例,鼓室探查、鼓室成形术4例,上鼓室开放、上鼓室外侧壁重建、鼓室成形术3例,颞骨次全切除术1例。结论:对于临床上表现为听力下降的鼓膜完整患者,应仔细检查鼓膜并及时行颞骨薄层CT及MRI检查,避免先天性胆脂瘤的漏诊,一旦确诊,应尽快手术治疗。
Objective:The clinical symptoms,imaging features and surgical treatment of congenital cholesteatoma are reported.Method:The clinical data of 20 patients with congenital cholesteatoma diagnosed and treated in our hospital from January 2016 to May 2018 were retrospectively analyzed,including the age of onset,clinical symptoms,signs,audiology,HRCT of temporal bone,surgical methods and so on.Result:In 20 patients with congenital cholesteatoma,the clinical manifestations were hearing loss in the affected ears,including 5 cases with ear fullness and 4 cases with tinnitus.There were 13 cases of local yellow-white shadow of tympanic membrane,5 cases of normal tympanic membrane and 2 cases of tympanic membrane bombe.Pure tone audiometry showed conductive deafness in 14 cases and mixed deafness in 6 cases.CT scan of temporal bone showed that 15 cases had pneumatic type of mastoid,4 cases had diploectic type and 1 case had sclerostic type.There were 15 cases of interspersed flocculent shadow and 5 cases of mass shadow.Among the 20 cases of chronic otitis media with cholesteatoma,6 have cholesteatoma in epitympanum,4 in tympanic cavity,3 in tympanic cavity and epitympanum,2 in mastoid and tympanic antrum,1 in mastoid,tympanic antrum and tympanic cavity,1 in tympanic antrum,tympanic cavity and petrous apex,1 in tympanic cavity,hypotympanum,posterior tympanum and ostium tympanicum tubae auditivae,1 in aditus ad antrum,epitympanum and posterior tympanum,1 in tympanic cavity,epitympanum and posterior tympanum.Intact canal wall mastoidectomy and tympanoplasty were performed in 7 cases,open mastoidectomy and tympanoplasty in 5 cases,middle ear exploration and tympanoplasty in 4 cases,atticotomy with reconstruction and tympanoplasty in 3 cases and subtotal temporal bone resection in 1 case.Conclusion:For patients with intact tympanic membrane presenting with hearing loss,the tympanic membranes should be carefully examined,and thin-section CT and MRI of temporal bone should be performed in time to avoid missed diagnosis of congenita
作者
梁文琦
王林娥
龚树生
王伟
LIANG Wenqi;WANG Line;GONG Shusheng;WANG Wei(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing,100032,China)
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
北大核心
2020年第1期45-48,共4页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
胆脂瘤
诊断
治疗
cholesteatoma
diagnosis
treatment
