胆脂瘤基质界定的临床研究

CLINICAL STUDY ON THE DEFINITION OF PERIMATRIX IN HUMAN EAR CHOLESTEATOMA

目的探讨中耳、外耳道胆脂瘤去除上皮后其基质对侵蚀行为的影响,以指导胆脂瘤手术方式的确定和预后评估。方法将60例中耳、30例外耳道胆脂瘤患者随机分为两组,各45例。一组去除胆脂瘤基质,二组保留胆脂瘤基质。观察两组患者术后的干耳率、干耳时间、胆脂瘤复发率以及微血管计数、胆脂瘤基质周围组织中炎症细胞浸润情况,术后随访3个月。结果两组患者术后干耳率分别为95.56%、93.33%,二者比较无统计学意义(P>0.05);一组的干耳时间为(21.1±4.8)d,二组为(37.8±3.7)d,两组比较有统计学意义(P<0.05);一组胆脂瘤复发率为4.44%,低于二组的15.56%(P<0.05);耳内术腔上皮化后皮肤微血管计数平均为(5.1±1.0)个/mm2,胆脂瘤基质周围微血管计数平均为(22.1±11.3)个/mm2,二者差异有统计学意义(P<0.05)。随着基质周围炎症程度的增加,胆脂瘤基质周围微血管计数也增加,呈递增趋势。结论微血管计数随着胆脂瘤基质周围炎症程度的增加而增加。新生血管形成可能是胆脂瘤侵蚀性行为的主要原因之一。在中耳、外耳道胆脂瘤上皮去除后胆脂瘤基质逐步失去胆脂瘤侵蚀行为能力,去除或者保留胆脂瘤基质对术腔上皮化无影响。

Objective To investigate the effects of middle ear,external auditory canal after the removal of epithelial matrix on the erosion of its behavior and to guide the way to determine cholesteatoma surgery and prognosis.Methods 60 cases of middle ear and 30 cases of external auditory canal were randomly divided into two groups with 45 cases in each.The first group received the removal of a cholesteatoma matrix,while the second group retained cholesteatoma matrix.Patients were observed after the dry ear rate,dry ear,cholesteatoma recurrence rate and microvessel count and cholesteatoma matrix surrounding tissue infiltration of inflammatory cells,and they were followed up for 3 months.Results Patients in both groups had the dry ear rates of 95.56% and 93.33% respectively（P0.05）.The first group had the time of dry ear of（21.1 ± 4.8） d,while the second group（37.8 ± 3.7） d（P0.05）.The first group had the cholesteatoma recurrence rate of being 4.44%,lower than 15.56% in the second group（P0.05）.The skin microvascular count average after ear surgical epithelization was（5.1 ± 1.0） / mm2,while the average microvessel count of the cholesteatoma matrix was（22.1 ± 11.3） /mm2（P0.05）.As the degree of inflammation around the matrix of cholesteatoma increased,the microvessel increased.Conclusion The counts of cholesteatoma matrix around the microvessel increased with increasing degree of inflammation.The formation of new blood vessels may be one of the main erosion behavior of cholesteatoma.In the middle ear and the external auditory canal after the removal of cholesteatoma epithelium,cholesteatoma matrix gradually lose the capacity of erosion.To remove or retain the cholesteatoma matrix of surgery has no effects on epithelization.