耳廓假性囊肿病理及治疗问题探讨

Investigation of clinical pathology and treatments on the auricle pseudocyst

目的 研究耳廓假性囊肿的临床病理学,探讨该病的治疗方法.方法 对西安交通大学医学院第二附属医院1993-2008年门诊和住院的60例耳廓假性囊肿患者行手术治疗,采用彻底切除囊肿外壁的软骨膜和新生软骨组织的方法,观察手术疗效和切除的囊壁组织,研究该病的病理学特点.结果 耳廓假性囊肿外壁的软骨膜是渗出性浆液之源.囊肿早期,其外壁系软骨膜,随着病程进展,囊肿外壁软骨膜增生、变厚、生成新生软骨.新生软骨由小变大,由薄变厚,最终形成整片软骨,此时浆液渗出终止,形成软骨间积液.最后软骨间积液被吸收、机化.囊肿内增生的软骨组织与耳廓软骨机化、粘连,导致耳廓增厚、变形.光镜下观察囊壁发现：纤维结缔组织增生,有少数血管扩张和淋巴细胞浸润.增生的纤维组织中有极薄到厚薄不一,乃至较厚的软骨细胞层,软骨陷窝囊和软骨细胞较小,软骨囊及基质呈嗜伊红色.故为新生软骨而非软骨退化变性.按照以上手术治疗的60例耳廓假性囊肿随访3个月至1年,均取得满意疗效,无耳廓变形等后遗症.结论 耳廓假性囊肿病理发展过程,可分为早期（急性渗出期）,中期（软骨形成期）和晚期（机化增生期）.治疗应根据其病理进展时期选择治疗方法.手术治疗的关键是彻底切除囊肿外壁的软骨膜和新生软骨组织,该手术方法简便易行,安全、可靠.

Objective To study the clinical pathology and treatments on the pseudocyst of auricle.Methods Sixty cases of auricular pseudocyst were treated by surgery from 1993 to 2008 in our hospital.Their operation effects and the clinic pathological features were analyzed. Results The clinic pathological data showed that the source of serous effusion of auricular pseudocyst origin from cartilage membrane in the top wall. In the early stage of the cyst, the top wall of auricular pseudocyst was the cartilage membrane.With the course progresses, the cartilage membrane in the top wall of auricular pseudocyst was proliferating,thickened and generated new cartilage. The new cartilage was formed from small piece to the big one, and eventually became an entire new cartilage on the top wall of auricular pseudocyst. Serous effusion at this time was terminated, and this cyst became intra-cartilaginous effusion of auricle. Finally the fluid between cartilages was absorbed and organized. In the cyst, the new cartilage and auricle cartilage were organized and adhered together each other. The auricle became thickened and deformed. The observation of capsule wall under light microscope showed that there were a few fibrous desmoplasia, anapetia and lymphocyte infiltrating in the fibrous tissue, as well as that there were cartilage cell layers from filminess to thicker. The cartilage cells and their lacunes were small, and the cartilage capsule and the basilaris substantia was showed as eosin. This data indicated that the cartilage was neogensis but not degenerating. Sixty patients were followed up from 3 months to 1 year. The effect of surgical treatment for the auricular pseudocyst was satisfactory.There was no auricular deformation in these patients with the operation.Conclusions Auricular pseudocyst can be divided into the early period （acute exudative period）, the medium period （cartilage formation period） and the late period （proliferative and organized period）. The treatment should be based on the pathological findings of auricular pseudocyst. The operation is easy, safe and reliable. The key of the operation is the complete removal of perichondrium and cartilage at the top of auricular pseudocyst.