颞骨CT在胆脂瘤型中耳炎中的诊断价值

Computed tomographic evaluation for the otitis media with chol esteatoma

目的：探讨颞骨高分辨率ＣＴ（ＨＲＣＴ）在胆脂瘤型中耳炎中的诊断价值。方法：回顾性总结１９９５年１月至１９９９年１２月本院收治的胆脂瘤型中耳炎患者３１６例（３３０耳）。术前均按常规进行颞骨ＨＲＣＴ扫描，再经术中显微镜下探查，记录病变结果与ＨＲＣＴ表现进行对比分析，以探讨ＨＲＣＴ的诊断价值。结果：盾板、鼓室及鼓窦天盖骨质缺损、乙状窦骨板骨质缺损等的术前ＨＲＣＴ与手术符合率１００％。而神经骨管骨质缺损，水平半规管骨壁破坏的符合率分别为６６．７％和７８．９％。软组织占位符合率为１００％，但是９０％为胆脂瘤与肉芽混合型；听小骨受侵符合率为９５％。结论：颞骨高分辨率ＣＴ对胆脂瘤型中耳炎的诊断，尤其对判定骨质缺损的范围与部位，制定手术方案和预估治疗效果，具有重要的指导意义。但ＣＴ诊断仍有其局限性，不能取代临床检查。

Objective:To investigate the value of high resolution computed tomography(HRCT)of temporal bone on the patients of otitis media with cholesteatoma.Method:The clinical data of 316 cases(330 ears)with cholesteatoma,which were examined by HRCT and treated by mastoidectomy(172 ears)or m astoidectomy+tympanoplasty(158 ears),were retrospectively analyzed from 1995 to 1999.There were 185 males and 131 females,ranging in age from 9 to 70 years old.Results:For the bone destruction,the rate of conformation between the radiographic and the operative findings was 100% in the lateral bone wall and tegmen of tympanic ,and the bone board of sigmoid venous sinus,95% for the ossicles,66.7% and 78.9% for the facial nerve bone canal and the lateral semicircular canal,respectively.For the soft tissue masses,the rate of conformation was 100%,however,in 95% of these was choleateatoma.Conclusion:HRCT scan has a role in diagnosis of cholesteatoma and especially about the bone erosion,but must be interpreted cautiously in view of its limitation and numerous pit fall. [Chinese Arch Otolaryngol Head Neck Surg,2002;9(1):16～19 From the Department of Otolaryngology-Head and Neck Surgery,Affiliated Beijing Tongren Hospital of Capital University of Medical Sciences,Beijing 100730(Dr.Cheng Jilong)]