外耳道胆脂瘤的诊断和治疗

Diagnosis and treatment of external auditory canal cholesteatoma

目的探讨外耳道胆脂瘤的临床特征和治疗方法。方法回顾性分析1990年1月至2005年1月期间共42例(44耳)外耳道胆脂瘤的临床资料。结果本组因外耳道骨性狭窄所致2耳,骨瘤阻塞所致2耳,其余主要与炎症、耵聍、挖耳损伤等有关。按Holt分期,Ⅰ期7耳,Ⅱ期22耳,Ⅲ期15耳。单纯外耳道胆脂瘤清除术25耳(门诊20耳)中,随访1-5年,外耳道胆脂瘤复发3耳,1耳上鼓室侵犯行改良乳突根治术;9耳伴有外耳道肉芽者,行外耳道肉芽切除术及外耳道胆脂瘤清除术后恢复良好,2耳伴有外耳道狭窄行外耳道成形术;改良乳突根治术5耳,乳突根治术2耳,随访6月～11年,无胆脂瘤复发,1耳术后外耳道口狭窄;先天性外耳道狭窄行外耳道成形术1耳,外耳道骨瘤切除及鼓膜成形术1耳,乳突骨瘤切除并外耳道成形术1耳。结论外耳道胆脂瘤多为自发性,具有破坏性,治疗原则是早期彻底清除胆脂瘤。

Objective To explore the clinical characteristies and treatment of external auditory canal cholesteatoma （EACC）. Methods The clinical data of 42 cases （44 ears） with external auditory canal cholesteatoma from January 1990 to January 2005 were retrospectively analysed. Results Among the cases of this study, 4 ears developed EACC following external auditory canal stenosis and osteoma, while the others developed EACC following cerumen, inflammation or earpick. The staging according to Holt disclosed that 7 ears were phase Ⅰ , 22 were phase Ⅱ , and 15 were phase Ⅲ. Twenty-five ears were treated by removing eholesteatomas from the external auditory canal simply. Nine ears were treated with combined removing EACCs and resection of graunlation tissues. Modified radical mastoidectomy and radical mastoidectomy were parformed in 5 and 2 ears, respectively. Combined canaloplasty was performed in 4 ears. EACC recurred in 3 ears and 1 ear developed stenosis at the orifice of external auditory canal during a follow-up period of 6 months to 11 years. Conclusion Bone erosions is a serious consequence of external auditory canal cholesteatoma. Completely removing cholesteatomas and graunlation tissues is crucial for the treatment of the disease.