累及颞骨岩部胆脂瘤的临床分析

Clinical analysis of petrous bone cholesteatoma

目的探讨累及颞骨岩部的胆脂瘤的临床特征和手术治疗。方法2003年2月-2006年6月该科收治的138例胆脂瘤患者中，有6例累及颞骨岩部，其中迷路上型1例，全迷路型3例，侵及岩尖者2例；先天性胆脂瘤1例，获得性胆脂瘤5例。面神经功能VI级（House-Brackmann分级）3例。6例患者中4例行耳蜗径路手术清除岩尖胆脂瘤，1例行扩大乳突根治术，1例行乳突根治术＋完桥式鼓室成形术。结果6例患者术后随访2~30月。面神经功能VI级2例，IV级1例。1例行完桥式鼓室成形术后仍为轻度聋，其余均全聋。1例随访2月，其余随访至少1年，均未见胆脂瘤复发。结论累及颞骨岩部的胆脂瘤病变范围广泛，可侵及内耳、面神经、大血管、硬脑膜等重要结构。乳突根治术或耳蜗径路的手术可彻底清除胆脂瘤。CT和MRI可以判断胆脂瘤的范围，并与岩部的其他疾病鉴别。MRI判断术后胆脂瘤是否复发有一定的价值。

Objective To explore the characteristics and surgical approach of petrous bone cholesteatoma. Methods The data of 138 patients with cholesteatomas who were referred to our hospital from February 2003 to June 2006 were retrospectively analyzed. Among them, six with petrous bone involved were found. According to Sanna＇s classification, one was supralabyrinthine petrous bone cholesteatoma, three were massive labyrinthine cholesteatoma, and two were apical cholesteatoma. One of the six was congenital and the other five were acquired. The facial nerve function was graded VI in three patients according to the House- Brackmann grading system. Radical mastoidectomy was performed in one of the six patients, and canal-wall-down tympanoplasty with mastoidectomy in another one, while transcochlear approach was employed in the other four. Results The patients were followed up for two to thirty months. The facial nerve function was graded Ⅵ in two patients and graded Ⅳ in one. Five experienced profound hearing loss after the surgeries except the one with canal-wall-down tympanoplasty. No recurrence of cholesteatoma was found during the follow-ups. Conclusion Important structures such as inner ear, facial nerve, great vessels and dura may be involved in petrous bone cholesteatoma which can be eradicated by mastoidectomy or surgery with transcochlear approach. CT and MRI can help to evaluate the extent of cholesteatoma and differentiate cholesteatoma from other diseases in the petrous bone. Furthermore, MRI is capable of evaluating recurrent cholesteatoma in some cases.