耳内镜直视下诊治外耳道胆脂瘤32例临床分析

Clinical Analysis of the Application of Otoendoscopic in the Course of Diagnosis and Treatment of EACC

目的:探讨耳内镜直视下诊治外耳道胆脂瘤(EACC)的临床价值。方法:回顾分析在耳内镜直视下诊断为EACC 32例患者的临床资料。结果:耳内镜检查示32例均见外耳道白色鳞状上皮样物或黑褐色豆腐渣状物堵塞,其中15例见外耳道有脓性引流和皮肤糜烂,8例伴有真菌感染,5例伴有外耳道炎性肉芽组织增生,12例见外耳道口或外耳道软骨部相对狭窄。术前纯音测听:22例语言频率(0.5～2kHz)听阈均值提高,骨气导差10～25dB,平均17.8dB,10例基本正常。术前颞骨高分辨力螺旋CT扫描检查示:所有患耳外耳道均见高密度软组织影及不同程度的骨质破坏吸收现象,其中3例乳突和上鼓室见高密度软组织影。耳内镜下治疗:术中见EACC直接破坏外耳道后壁及下壁,严重者甚至侵入乳突,形成外耳道后壁-乳突腔瘘。术中彻底清理胆脂瘤上皮、肉芽及坏死骨质。术后听力纯音测听:32例中22例语言频率(0.5～2kHz)较术前提高10～20dB,无变化10例,均达到应用水平(30dB)。术后随访观察1～3年,均未见复发。结论:EACC是一种慢性破坏性疾病,临床上易被误诊。在耳内镜直视下检查有助于发现细小的病变,利于早期诊断。耳内镜直视下治疗外耳道胆脂瘤,手术中有有良好的照明和清晰的视野,可对病变部位进行精确定位,明确病变组织与外耳道及中耳结构的关系,利于彻底清除外耳道深在、狭小空间内EACC病灶,从而提高了手术的治愈率,减少了复发率,并避免了并发症的发生。另外,耳内镜直视下治疗外耳道胆脂瘤一般无需外耳道切口,创伤小,术后恢复快,费用低。

Objective : To explore the clinical application value of otoendoscopic in diagnosis and treatment of cholesteatoma of external auditory canal(EACC).Methods : A retrospective analysis of clinical data was carried out among 32cases with EACC treated under otoendoscopic.All the cases were diagnosed on the basis of pathological determination.Results : The patients with EACC were examined under otoendoscopic.All the cases were accumulated with white squamous epithelium or cheese in external auditory canals.The bones of the bottom of external auditory canals were eroded and enlarged distinctively.15cases of them were found with purulent secretion and skin lesions,5cases with granulation tissue and 12cases with stenosis or relative stenosis of external auditory canals.The preoperative CT scanning of temporal bone demonstrated shadow of soft tissue in external auditory canal and destruction of bone.Shadow of soft tissue in attic or mastoid was found in 3cases.The posterior parts of the canal wall were often eroded by the disease,and the fistulas between canal and mastoid could be found.Treatment consists of the removal of the cholesteatoma sac,granulation tissue and sequestra.There was no recurrence in 1to 3years follow-up and hearings of 22cases were improved to 10-20db with 10cases no change.Conclusion : EACC is a kind of chronic destroying diseases and is easily misdiagnosed.Examination under otoendoscopic is helpful to detect small lesions,conducive to the early diagnosis.EACC operation under otoendoscopic with good lighting and a clear vision can accurately locate the lesions,ascertain the relationship among lesion tissue,the external auditory canal and middle ear structure,help to completely remove EACC in deep,narrow space.The operation also can reduce operation blindness,prevent the operation complications,increase the success rate of operation and reduce the relapse rate.At the same time,there is no need of incision in external auditory canal.With less trauma,faster postoperative recovery and low cost,the application of otoendoscopic is of important clinical value in the course of diagnosis and treatment of EACC.