中耳胆固醇肉芽肿的个体化手术治疗

Individualized surgical treatment of middle ear cholesterol granuloma

目的探讨中耳胆固醇肉芽肿(cholesterol granuloma,CG)的手术方式及治疗效果。方法回顾性研究接受手术治疗的38例中耳CG患者的临床资料,7例患者行鼓室探查+鼓膜置管,19例患者行完壁式乳突切开+鼓室成形+鼓膜置管,12例患者行开放式改良乳突根治+鼓室成形+鼓膜置管。采用SPSS 17.0软件对手术前后数据进行对比。结果术后随访半年以上,7例患者复发,其中行鼓室探查+鼓膜置管术复发1例;行完整式乳突切开+鼓室成形+鼓膜置管术复发3例;行改良乳突根治+鼓室成形+鼓膜置管术复发3例;其中4例接受再次手术后未再复发。3种术式患者术后听力均较术前有明显提高。结论中耳CG患者的主要临床特征是听力下降、耳闷塞感、耳鸣、蓝色鼓膜、外耳道酱油或血水样液。治疗中耳CG应根据病情选择个体化的手术方式,手术治疗可有效缓解症状、提高听力。

Objective To investigate the surgical treatment and therapeutic effect of middle ear cholesterol granuloma（ CG）. Methods 38 patients with middle ear CG surgically treated in our department were included. Clinical data including clinical features,surgical procedures and therapeutic effect were analyzed retrospectively. Results The main clinical features of patients with middle ear CG were hearing loss,ear choking sensation,tinnitus,blue eardrum and soy sauce-like or blood-like liquid in external auditory canal. 7 cases were treated with tympanic exploration and tympanic tube insertion,19 with end wall mastoidectomy,tympanoplasty and tympanic tube insertion,12 with modified open radical mastoidectomy,tympanoplasty and tympanic tube insertion. All patients were followed up more than half a year.Recurrence occurred in 7 patients and 4 received reoperation without recurrence. No matter what kind of surgical procedure performed,the hearing of patients was obviously improved. Conclusions Individualized surgical procedure should be selected according to conditions of patients with middle ear CG. Surgery can effectively relieve symptoms and improve hearing.