耳内镜下经外耳道切除上鼓室胆脂瘤35例疗效分析

Effects of transcanal endotoscopic management of epitympanic cholesteatoma in 35 cases

目的探讨耳内镜下经外耳道入路治疗上鼓室胆脂瘤的可行性、手术方法及疗效。方法回顾分析2014年1月～2017年1月在徐州市中心医院接受耳内镜手术的35例(35耳)中耳上鼓室胆脂瘤患者的临床资料。35例患者中男20例,女15例;年龄22～66岁,平均年龄42. 8岁;病程2～20个月,平均10个月。所有患者均在全麻耳内镜下手术,根据胆脂瘤大小决定手术范围。12例行上鼓室重建,10耳听骨链破坏或缺失者,行部分人工听骨重建(partial ossicular replacement prosthesis,PORP)。结果 35耳上鼓室胆脂瘤病灶均彻底清除,未出现面瘫及脑脊液漏等并发症。所有患者术后随访1年以上,患者鼓膜愈合良好,移植物形态良好。耳内镜检查或者颞骨薄层CT检查未见胆脂瘤复发,术后听力提高22例(62. 8%),听力无变化10例(28. 6%),听力下降3例(8. 6%),平均气导听阈与气骨导差均有改善,术后0. 5、1、2、4 k Hz平均气导听阈为(29. 234±8. 38) d B,与术前的(43. 64±8. 38) d B比较差异具有统计学意义(P <0. 05);术后0. 5、1、2、4 k Hz平均气骨导差值为(15. 27±6. 74) d B,与术前的(28. 27±5. 94) d B比较差异具有统计学意义(P <0. 05)。结论耳内镜下经外耳道上鼓室胆脂瘤切除术是有效的手术方法,复发率低,听力改善明显,与传统显微镜手术相比有优越性。

Objective To explore the feasibility, surgical technique and therapeutic effect of transcanal endotoscopic management for epitympanic cholesteatoma. Methods Clinical data of 35 patients( 35 ears) undergoing transcanal endotoscopic resection of epitympanic cholesteatoma in Central Hospital of Xuzhou City from Jan 2014 to Jan2017 were analyzed retrospectively. Of them,20 were male and 15 were female,age ranged from 22 to 66 years old with an average of 42. 8. Their illness courses were 2 to 20 months,with an average of 10 months. All the patients received transcanal endotoscopic removal of epitympanic cholesteaoma under general anesthesia. Of them,attic reconstruction was applied to 12 cases,and 10 received reconstruction of ossicular chain with partial ossicular replacement prosthesis( PORP)due to erosion of the ossicular chain. Results Complete removal of epitympanic cholesteatoma was achieved in all 35 cases without postoperative complications such as facial nerve paralysis,cerebrospinal fluid otorrhea. All patients had been followed up for at least one year postoperatively. Postoperative follow-up revealed intact tympanic membrane with healed graft. Postoperative otoscopy or computerized tomography( CT) showed no recurrence of cholesteatoma. The postoperative hearing got improved in 22( 62. 8%),kept unchanged in 10( 28. 6%),and was declined in 3( 8. 6%). The preoperative mean air conduction threshold( 0. 5,1,2,4 k Hz) was( 43. 64 ± 8. 38) d B while the postoperative one was( 29. 234 ± 8. 38) d B,and the difference was statistically significant( P < 0. 05). The preoperative mean air-bone gap was( 28. 27 ± 5. 94) d B,and the postoperative one was( 15. 27 ± 6. 74) d B. The difference was also statistically significant( P< 0. 05). Conclusion With advantages of low recurrence rate and significant improvement of hearing,transcanal endotoscopic surgery is effective for the management of epitympanic cholesteatoma.