摘要
目的总结中耳胆固醇肉芽肿(cholesterol granuloma,CG)经中耳乳突手术治疗的经验并探讨其治疗策略。方法回顾性分析我院2010年1月至2019年9月期间接受手术治疗的45例(45耳)中耳CG患者的临床资料。根据CG的不同病变特点采取个性化的手术方式,观察治疗效果,总结治疗经验。结果①根据术中所见的大体组织病理状态,将患者分为以渗出及分泌物潴留为主的潴留型,以肉芽肿组织增生为主的肉芽型。5例潴留型患者全部接受完壁式乳突根治、鼓室成形术,其中2例患者同期行鼓膜切开置管术。40例肉芽型患者中21例行开放式乳突根治、鼓室成形术,其中5例行鼓膜切开置管术;19例行完壁式乳突根治、鼓室成形术,其中7例行鼓膜切开置管术。一期鼓膜置管率总体为31.11%。②术后随访0.5~9年。有4例(8.89%)复发,病理类型均为肉芽型。其中3例为完壁术式术后复发,1例为开放术式,此次修订手术皆采用开放式乳突根治术,术后患者恢复良好,无复发。其余41例患者恢复良好。术后患者气导平均提高8.00±17.92dBnHL,气-骨导差平均提高5.82±14.46 dBnHL,两组患者差异均无统计学意义(P>0.05)。③在肉芽型患者中,完壁术式术后复发率为15.79%,开放术式术后复发率为4.76%。结论中耳CG的总体治疗原则为手术彻底去除病变、建立乳突-鼓室-咽鼓管或乳突-鼓室-外耳道良好的通气系统。鼓膜置管在多数情况下需要采用。根据CG的病变特点可分为潴留型和肉芽型,潴留型推荐完壁式乳突根治术,肉芽型推荐开放式乳突根治术。
Objective To summarize effects of mastoidectomy in treating middle ear cholesteryl granuloma(CG)and management strategies.Methods Clinical data from 45 patients(45 ears)with middle ear CG confirmed by pathology were analyzed retrospectively.,Surgical techniques were chosen according to intraoperative findings,and therapeutic outcomes were analyzed and summarized.Results Findings during operation could be categorized as retention(5 cases),characterized by exudation and secretion retention and granulation(40 cases),with granuloma tissue hyperplasia.Canal wall up radical mastoidectomy was performed for retention cases.For granulation cases,21 received canal wall down mastoidectomy and 19 received canal wall up mastoidectomy.Tympanic tubes were inserted in 31.11%of the cases.During the follow up of 0.5-9 years,granulation recurred in 4 cases(8.89%),with 3 after the canal wall up radical mastoidectomy and 1 after canal wall down mastoidectomy.Revision canal wall down mastoidectomy was performed in these cases with good recovery and no more recurrence.Hearing improved after operation in most of the patients,with an average improvement of air conduction threshold of 8.00±17.92 dB.The average increase of air-bone gap was merely 5.82±14.46 dB(P>0.05).In granulation cases,the recurrence rate was 15.79%after canal wall up radical mastoidectomy,and 4.76%after canal wall down mastoidectomy.Conclusion In general,the key treatment principle in middle ear CG is complete removal of the lesion and establishment of an adequate mastoid-tympanum-eustachian tube or mastoidtympanum-external auditory canal ventilation system.Tympanic tube insertion is needed in most cases.Middle ear CG can be categorized as retention or granulation.Canal wall up surgery is recommended for the former and canal wall down surgery for the latter.
作者
孙素花
张绍兴
王宇
潘滔
SUN Suhua;ZHANG Shaoxing;WANG Yu;PAN Tao(Department of Otorhinolaryngology Head and Neck Surgery,Third Hospital of Peking University,Beijing 100191,China)
出处
《中华耳科学杂志》
CSCD
北大核心
2021年第3期419-422,共4页
Chinese Journal of Otology
关键词
中耳胆固醇肉芽肿
手术治疗
乳突根治术
Cholesterol Granuloma of Middle Ear
Surgical Treatment
Radical Mastoidectomy
