外耳道胆脂瘤的诊断与外科治疗

DIAGNOSIS AND SURGICAL TREATMENT OF EXTERNAL AUDITORY CANAL CHOLESTE-ATOMA

[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1995年1月～2005年6月期间经手术治疗的46例(48耳)外耳道胆脂瘤患者的临床资料。手术方法主要为外耳道胆脂瘤清除术;伴外耳道肉芽者行外耳道肉芽切除术,伴外耳道狭窄者行外耳道成形术。[结果]24例行单纯外耳道胆脂瘤清除术的患者听力恢复正常19例,5例改善;10例伴外耳道肉芽患者行外耳道肉芽切除术和外耳道胆脂瘤清除术后恢复良好,听力恢复正常,无复发;3例伴外耳道狭窄行外耳道成形术后恢复良好;3例行乳突根治术,6例行改良乳突根治术的患者,其中2例术后发生外耳道口狭窄,胆脂瘤无复发;其余患者均恢复良好。随访6月～10年,外耳道胆脂瘤复发4例,再次清理治愈;1例因侵犯中耳及上鼓室,于1年6个月后行改良乳突根治术治愈。[结论]外耳道胆脂瘤多为自发性,对耳和周围的软组织及骨组织具有破坏性。治疗原则是采用手术早期彻底地清除胆脂瘤。

[ Objective] To investigste the clinical characteristics and treatment of external auditory canal cholesteatoma （EACC）. [Methods] The clinical data of 46 cases （48 ears） with external auditory canal cholesteatoma treated with surgery from January 1995 to June 2005 were retrospectively analysed. [ReSults] Among the 24 cases of EACC patients who were only given clearing surgery of EACC, 19 cases recovered and 5cases turned better. As to the 10 EACC patients combined with exteroal auditory canal granulation who were given surgeries of granulation resection and cholesteatoma clearing, all recovered well and no one recurred. And 3 EACC patients combined with external auditory canal stenosis who received external auditory canal plasty got recovery. While of the 3 cases performed radical mastoidectomy and 6 cases performed modified radical mastoidectomy, 2 cases had external auditory canal stenosis after operation and no EACC recurrence, others recovered well. With a follow up from 6 months to 10 years, 4 cased had EACC recurrence and recovered by another surgery of EACC clearing, and lcase with erosions of middle ear and atticus was cured by modified radical mastoidectomy one year and six months later. [ Conclusion] External auditory canal cholesteatoma is spontaneous and has erosive effects on ear and the soft tissue and bone tissue around. So the therapeutic principle is completely removing cholesteatomas in early stage of operation.