外耳道胆脂瘤的影像学特征和处理方法的选择

Imaging features and surgical approach of external auditory canal cholesteatoma

目的:探讨外耳道胆脂瘤(EACC)的表现特征和处理方法。方法:对17例(21耳)入院手术治疗的EACC患者的临床资料进行回顾性研究,分析其病因、病史、临床表现和影像学特点,探讨这些特点对临床处理方法的影响。结果:8耳行外耳道成形和EACC切除;1耳术中仅行外耳道成形和EACC切除,待二期行鼓室成形手术;3耳清理鼓室内病变后将颞肌筋膜内植,行鼓膜修补。9耳采用耳后切口,行开放式乳突根治。结论:EACC的病因学特点和病变的范围决定其处理方式,颞骨CT有助于了解病变的范围,制定手术计划。

Objective： To define the clinical and imaging features of external auditory canal cholesteatoma （EACC） and determine the characteristics most important to its clinical management. Method：Seventeen cases （21 ears） of EACC were retrospectively reviewed. Clinical data were collected for the history, presentation, physical examination findings and CT scans. The surgical management approaches were reviewed. Result： Patients presented with otalgia（ n = 21）, otorrhea（ n = 16）, ear-canal stenosis（ n = 11）, facical nerve dysfunction （ n = 4）. CT scans showed a soft tissue mass with adjacent bone erosion （ n =21）. Middle ear and mastoid involvement （ n = 9）, facial canal erosion（ n =4）, sigmoid sinus erosion（ n = 1） and jugular bulb dehiscence（n= 1） were observed. EACC excision and canaloplasty through transcanal approaches were performed in 12 ears, while postauricular incision and canal wall down mastoidectomy were used in 9 ears. Conclusion： The possible causes of EACC and its possible extension may influence clinical management. Preoperative high-resolution temporal bone CT scans can be helpful in the diagnosis and management of EACC.