儿童中耳胆脂瘤16例临床分析

Clinical analysis of 16 pediatric patients with cholesteatoma in middle ear

目的探讨儿童中耳胆脂瘤的诊断及治疗。方法回顾性分析该科2001年9月-2005年11月收治的经临床诊断和病理证实的16例（16耳）儿童中耳胆脂瘤的临床表现、影像学结果及手术经验，其中行开放式乳突切除加鼓室成型术13例，乳突根治术3例。结果术后随访半年到4年，全部患儿胆脂瘤无复发，无面瘫，一期干耳15例（95.8%），1例术后3月术腔肉芽生长经再次清理后干耳。纯音听力测试较术前略提高3例、持平4例、下降9例。结论儿童中耳胆脂瘤侵蚀性较成人强，临床表现复杂多样、隐匿且不典型，CT或MR I检查有助于提高早期诊断率和防止并发症，手术方法应依据病变的范围、听骨链的破坏程度及残余听力情况加以选择，手术中彻底清理病灶是预防复发的关键。

Objective To study the diagnosis and treatment of cholesteatoma in the middle ear in children. Methods A retrospective analysis was conducted on 16 pediatric patients with cholestestoma in the middle ear who were hospitalized within September 2001 and November 2005. All of them were clinically diagnosed and pathologically confirmed. The clinical manifestations, imaging data and surgical precedures were reviewed. Of the 16 patients, 13 were performed canal-wall-down tympanoplasty with mastoidectomy and 3 radical mastoidectomy. Results During the follow-up of 6 months to 4 years, no recurrent cholestestoma was observed and no one experienced facial palsy. Fifteen cases （95.8%）were cured in first-stage surgery, while the other one was removed granulation in the third month after surgery. The hearing threshold of 3 patients were improved,4 had no change,and 9 were decreased. Conclusion The cholesteatomas in children are characterized by a variety of presentations which are often invisible. CT and MRI examination may help to make early diagnosis and prevent the complications. Complete removal of diseased tissues （cholesteatoma and granulation） , restoration of ossicular chain and prevention of compilications are the key points in the surgical procedures.