摘要
目的探讨合并胆脂瘤型中耳炎的胆固醇肉芽肿发病原因。方法回顾分析12例合并胆脂瘤型中耳炎的胆固醇肉芽肿患者的影像检查、手术探查及术后随访等临床资料。结果12耳颞骨CT均显示上鼓室、鼓窦、乳突蜂房内软组织影,听小骨周围软组织影,听骨链残缺或显示不清;12耳手术探查可见鼓窦入口均被袋状胆脂瘤完全阻塞,但咽鼓管均通畅;随访2～3年,临床观察无胆脂瘤或胆固醇肉芽肿复发。结论胆脂瘤型中耳炎与胆固醇肉芽肿二者并存时,形成胆固醇肉芽肿的原因主要是机械性阻塞。乳突-鼓窦-鼓室含气系统内任何位置的阻塞都有可能造成其后的部位形成胆固醇肉芽肿,而不仅限于咽鼓管功能不良。对于这类患者,在保证咽鼓管通畅的前提下,行乳突根治术的同时可以考虑同期行鼓室成形术以重建听力。
OBJECTIVE To investigate the etiologyand pathogenesis of cholesteatoma otitis media coex-isted with cholesterol granuloma, and the relationship between cholesteatoma and cholesterol granuloma.METHODS Twelve cases (twelve ears) of choleste-atoma otitis media with cholesterol granuloma weretreated in our hospital from Jan. 2001 to Feb.2002. Allcases were pathologically confirmed. RESULTS Tem-poral bone CT scan demonstrated all cases with opacifi-cation of the hypertympanum, tympanic antrum and aircells of mastoid bone by soft tissue mass. Six earsshowed enlargement of antrum. The ossicular chains werewrapped and shifted in all 12 ears. The surgical explora-tion revealed that the aditus of antrum was blocked byretraction pocket. The ventilation of Eustachian tubein all cases was normal. All patients underwent tym-panoplasty as well as mastoidectomy. During a fol-low-up of 2～3 years (average 28 months), all hear-ing gain is sustained with no clinical recurrence.CONCLUSION The main cause of cholesterol granu-loma in cholesteatoma otitis media is mechanicalobstruction, while the stimulus of cholesteatoma com-ponents cannot be excluded. Any obstruction within theventilation system of middle ear, not merely in Eustachiantube, may lead to the formation of cholesterol granuloma.Asto those patients, mastoidectomy should be performed inorder to restore the ventilation, and hearing reconstructionby tympanoplasty should be also under consideration.
出处
《中国耳鼻咽喉头颈外科》
北大核心
2005年第5期295-297,共3页
Chinese Archives of Otolaryngology-Head and Neck Surgery
