上鼓室胆脂瘤的手术治疗

Surgical management of epitympanic cholesteatoma

目的探讨并评价通过开放式和完桥式鼓室成形术治疗上鼓室胆脂瘤的临床效果。方法分析2005年5月至2010年5月间手术、随访至少12个月的45例上鼓室胆脂瘤患者行开放式鼓室成形术和12例完成完桥式鼓室成形术的病例,并对其临床效果进行评估。结果所有病例随访不少于12个月,干耳时间4～6周。移植鼓膜一期愈合54例。2例植入的人工听骨脱出,改为植入钛合金听骨。1例施行完桥式手术者于面神经隐窝处复发,改行开放式手术。术后纯音测听气骨导间距≤10 dB者占42.1%(24/57),11～20 dB者占24.6%(14/57),21～30 dB者占22.8%(13/57),≥31 dB者占10.5%(6/57)。结论术前颞骨高分辨率CT的检查结果和术中病变范围的确定有助于手术方式的选择,对于病变范围较广泛的选择开放式手术,而对于范围相对局限的病例选择完桥式鼓室成形术,在根除病灶的基础上保存或提高听力,是较佳的优化治疗选择。

Objective To investigate and evaluate the effects of the two surgical methods in treating epitympanic cholesteatoma with intact pars tensa of the tympanic membrane.Methods retrospective review was performed of canal wall-down tympanoplasty（CWDT） with ossiculoplasty in a single stage and 12 cases with an intact-bridge tympanomastoidectomy during the time interval from May,2005 to May,2010.Results The outcome of dry ear and well-epithelialized mastoid cavities was achieved about 4-6 weeks.After 1 year follow-up,recurrent cholesteatoma occurred in 1case postoperatively with intact-bridge tympanomastoidectomy.The postoperative pure tone average was compared with the preoperative levels.The postoperative air-bone gap within 10 dB was obtained in 24 cases,11~20 dB in 14 cases,and 21~30 dB in 13 cases.Conclusion Epitympanic cholesteatoma should be diagnosed early.If it can be treated by preoperative temporal bone CT scanning and intraoperative clinical fingings properly,not only the removing of cholesteatoma,but also the reservation and improvement of the hearing of the diseased ears can be obtained.