摘要
目的 探讨外耳道胆脂瘤的病因及骨破坏的机理。方法 采用回顾性研究方法,总结分析经临床和病理确诊的29例(30耳)外耳道胆脂瘤的临床诊治情况。结果 本组除9例(9耳)为外耳道狭窄所致,其余均为自发性外耳道胆脂瘤;本组病例均有不同程度、不同方向的骨性外耳道侵蚀扩大。其中15例侵入乳突鼓窦及上鼓室,6例面神经垂直段骨管破坏,2例面神经部分裸露伴轻微面瘫,2例外耳道前壁死骨形成,2例伴有脑板破坏;18例(19耳)鼓膜完整,11耳鼓膜紧张部穿孔,3例听骨链破坏。本组均采用了显微镜下病灶清除术,未发生并发症,术后随访半年～5年无复发。结论 外耳道胆脂瘤发病率明显低于胆脂瘤性中耳炎,两者具有相同的组织来源为鳞状上皮过度增生,具有骨质破坏等生物学行为;白介素-Ⅰ(IL-Ⅰ)、肿瘤坏死因子-α(TNF-α)及多种免疫细胞等可能直接参与鳞状上皮的过度增生和骨破坏。早彻底清除病灶是根治本病、防止并发症发生的唯一手段。
Objective To explore the causes of cholesteatoma of external auditory canal responsible for bone erosion induced by this lesion. Methods A retrospective study was carried out among 29 cases (30 ears) with this lesion treated in our hospital. All the cases were diagnosed on the basis of pathological determination. Results Among the cases of this group, 9 were developed following external auditory canal stenosis and the other were all seen being a spontaneous lesion. All of them were accompanied with bony erosion of external auditory canal at various degrees, including invasion to mastoid, antrum and epitympanum, the facial canal, skull plate and sequester formation in the anterior wall of external bony canal. Furthermore, 18 cases (19 ears) were seen with intact tympanic membrane, 11 with perforation in the ear drum and 3 with destruction of ossicular chain among these cases. They were all treated by microsurgery with no reoccrrence during a following up period of 5 years. Conclusions The histogenesis of cholesteatoma of external auditory canal is due to excessive hyperplasia of squamous epithelia in the canal, with the property of bone erosion in its biological behavior. Here, IL-1, TNF-α and various immunic cells might directly be involved in the process of excessive squamous epithelia hyperplasia and bone erosion.
出处
《中国中西医结合耳鼻咽喉科杂志》
2003年第4期170-172,共3页
Chinese Journal of Otorhinolaryngology in Integrative Medicine
