高分辨率CT对慢性化脓性中耳炎术前病变评估及术式选择的临床价值

Clinical Roles of High Resolution Computerized Tomography in Preoperative Assessments and Approach Selection in Patients with Chronic Suppurative Otitis Media

【目的】探讨颞骨高分辨率CT(HRCT)对慢性化脓性中耳炎术前病变评估及术式选择的临床价值。【方法】收集慢性化脓性中耳炎患者77例术前HRCT检查,按HRCT检查提示有无中耳骨质破坏分为A、B组,将术中所见(包括上鼓室、鼓窦病变组织性质,听骨链缺损及咽鼓管鼓室口病变,解剖异常)与术前颞骨HRCT诊断比较。【结果】A组32例HRCT显示上鼓室、鼓窦、乳突有软组织影充填,无骨质吸收或破坏,均行鼓窦凿开探查,5例行封闭式鼓室成形术,21例行开放式鼓室成形术,6例行鼓窦探查术+鼓膜成形术,术中上鼓室鼓窦病变组织性质(肉芽、胆脂瘤)、听骨链病变、咽鼓管鼓室口病变与HRCT诊断符合率分别为68.8%、0、66.7%、60%;B组45例HRCT显示上鼓室、鼓窦、乳突有软组织影充填,骨质有吸收或破坏,3例行封闭式鼓室成形术,40例行开放式鼓室成形术,2例行乳突根治术,术中上鼓室鼓窦病变组织性质(肉芽、胆脂瘤)、听骨链病变、咽鼓管鼓室口病变与术前CT显示的病变符合率分别75%、89.7%、90%、64.3%。HRCT较好显示中耳乳突解剖异常(乙状窦前位、天盖低位、颈静脉高位)及乙状窦壁、天盖、骨性半规管骨质破坏情况,与术中发现符合率100%。【结论】颞骨HRCT检查对慢性化脓性中耳炎术式选择、手术入路和病灶清除及手术的安全性有重要参考价值,对上鼓室鼓窦病变性质、听骨链破坏评估的准确性存在一定局限性,随着中耳病变加重并出现骨质破坏,准确性相应增加。

[Objective] To analyze the clinical roles of high resolution computerized tomography （HRCT） in preoperative assessments and approach selection in the patients with chronic suppurative otitis media （CSOM）. [Methods] 77 patients suffering from CSOM were divided into two groups according to their preoperative HRCT results showing bone erosion whether or not. The operative findings, such as attico-antral lesions, ossicular destruction, focus of infection in tympanic opening of auditory tube and anatomic abnormalities were analyzed and checked if HRCT scan confirmed them or not. [Results] In Group A, HRCT indicated that soft-tissue mass filled attico-antra and mastoid air cells without bone erosion in 32 patients. All of them were undergone attico- antrotomy. Closed tympanoplasty was operated in 5 patients, open tympanoplasty in 21 patients and myringoplasty in 6 patients. The consistent rate of HRCT scan with operative findings such as attico-antral granulation and cholesteatoma, ossicular erosion, focus of infection in tympanic opening of auditory tube in different approaches above were 68.8%, 0, 66.7%, and 60%, respectively. In Group B, HRCT indicated that soft-tissue mass filled attico-antra and mastoid air cells with bone erosion in 45 patients, of whom closed tympanoplasty was operated in 3 patients, open tympanoplasty in 40 patients and radical mastoidectomy in 2 patients. The consistent rate were 75%, 89.7%, 90%, and 64.3%, respectively. Moreover, HRCT was good at detecting abnormalities of the middle ear, such as the antelocation of the sigmoid sinus, the depression of the tegmental plate and the projection of the jugular bulb, and bone erosion of sigmoid sinus, tegmen and semicircular canals. The consistent rate was 100%. [Conclusions] Temporal bone HRCT scanning played an important clinical role in patients with CSOM. It can help the doctor to select operative approaches and assess the safety. However, it was limited to detection of attico-antral and ossicular lesions. The accuracy may be improved as the middle ear changes get worse and complicated by bone destruction.