鼓室球体瘤12例误漏诊原因分析及治疗体会

Misdiagnosis and Missed Diagnosis Analysis and Treatment Experience in 12 Patients with Glomus Tympanicum Tumor

目的分析鼓室球体瘤的临床特点及治疗方法,总结防范误漏诊的措施。方法回顾性分析我院12例鼓室球体瘤误漏诊临床资料。结果 12例均为单耳发病,听力下降10例,搏动性耳鸣7例,耳道新生物5例,耳道分泌物4例,耳道间断出血1例。术前11例误漏诊,误诊为胆脂瘤型中耳炎5例（41.7%）,外耳道胆脂瘤2例（16.7%）,外耳道肉芽肿、血管瘤各1例（8.3%）,漏诊2例（16.7%）,均经术后病理检查确诊;仅1例术前经活组织病理检查确诊。12例均行手术治疗,术后随访1-3年无复发。结论鼓室球体瘤与中耳炎性疾病鉴别困难,充分的影像学检查并配合病理检查对减少本病误漏诊十分重要;治疗以手术为主,预后良好。

Objective To analyze the clinical characteristics and treatment methods of glomus tympanicum tumor,in order to reduce the misdiagnosis and missed diagnosis rates. Methods Clinical data of 12 cases of glomus tympanicum tumor in my department were retrospectively analyzed. Results All the 12 cases were single ear disease,10 cases of hearing loss,7 cases of pulsatile tinnitus,5 cases of ear canal mass,4 cases of ear canal secretion,1 case of ear canal continual bleeding.11 cases were preoperatively misdiagnosed as middle ear cholesteatoma in 5 cases（ 41. 7%）,external auditory canal cholesteatoma in 2 cases（ 16. 7%）,external auditory canal granuloma in 1 case（ 8. 3%）,hemangioma in 1 case（ 8. 3%）. 2 cases（ 16. 7%） were missed diagnosis. Only 1 case was confirmed by preoperative pathological examination. The 12 patients underwent surgical treatment and postoperative pathological examination and they were diagnosed with glomus tympanicum tumor. All the patients were followed up for 1 to 3 years with no recurrent lesions. Conclusion It is difficult to differentiate glomus tympanicum tumor from middle ear inflammatory disease. Adequate imaging examination combined with pathological examination are necessary in reducing the misdiagnosis rate. Surgery is a preferred approach in treatment of glomus tympanicum tumor with good prognosis.