儿童中耳胆脂瘤的临床特点及治疗

Clinical characteristics and surgical management of middle ear cholesteatoma in children

目的 探讨儿童中耳胆脂瘤的临床特点及外科治疗。方法 分析27例儿童中耳胆脂瘤病例的临床症状及体征、手术经验,其中2例采用外耳道径路上鼓室开放＋鼓室成形术,25例采用开放式乳突根治＋鼓室成形术,其中5例一期行听骨链重建。结果 临床症状以耳部流液、耳异味、听力下降为主;术中见胆脂瘤侵犯乳突腔、鼓窦及上鼓室25例（92.6%）,中鼓室、下鼓室及咽鼓管20例（74.1%）,听骨链破坏24例（88.9%）,面神经骨管破坏7例（25.9%）。术后病理均符合胆脂瘤,随访1年~5年,27例术后均无面瘫,无颅内并发症,均未复发。结论 儿童中耳胆脂瘤病变广泛、破坏性大,应根据病变的严重程度选择相应的手术方式,病情严重者选择开放术式。

Objective To investigate the clinical characteristics and surgical management of middle ear cholesteato- ma in children. Methods 27 cases of children with middle ear cholesteatoma were enrolled in this study; Clinical symptoms, signs and surgical experience were reviewed. Of 27 patients, 2 were performed transmeatal atticotomy and tympanoplasty, 25 were performed canal-wall-down modified radical mastoidectomy, and 5 were performed first-stage ossicular chain reconstruction. Results Otorrhea, ear odour and hearing loss were the most common symptoms; Mastoid, sinus tympani and attic were involved in 25 cases; Mesotympanum, hypotympanum and eustachian tube were in- volved in 20 cases; 88.9% of patients had ossicular chain destruction; Facial nerve canal was eroded in 7 cases; During the follow-up of one to five years, there was no one with significant complications as facial palsy and intracranial complica- tions, no recurrent cholesteatoma was observed. Conclusions The middle ear cholesteatoma in children show more aggres- sive in complicated condition, appropriate surgical approach should be selected according to the severity of the lesion, opened technique is benificial to complete removal of lesions and prevent recurrence in severe patient.