外耳道胆脂瘤35例的临床观察及术式选择

Study on clinical features and strategy for surgical treatment of cholesteatoma in external auditory canal: a report of 35 cases

目的对外耳道胆脂瘤患者发病特点及手术方式进行探讨。方法纳入35例外耳道胆脂瘤手术病例,对其年龄、性别、分期及手术方式和术后效果进行统计分析。结果术后2周:35例均干耳,术后4周:II期患者耳道上皮生长完全无复发;III期患者行乳突开放且未重建外耳道后壁者7例乳突腔尚未完全上皮化,其余14例中13例均上皮生长完全无胆脂瘤复发;1例外耳道成型+鼓室成型者出现耳道肉芽生长再狭窄,再次手术并植皮。术后3个月:7例乳突根治后未重建外耳道后壁者乳突上皮化。均无胆脂瘤复发。其中11例随访1年,均无胆脂瘤复发,耳道无狭窄。结论外耳道胆脂瘤各年龄段发病不同,手术方式宜根据气化程度、病变严重程度及听力状况个体化选择。

Objective To explore the clinical features and strategy for surgical treatment of chlolesteatoma in external auditory canal.Methods The clincal data of thirty five patients with cholesteatoma in external auditory canal were retrospectively reviewed. Their age range,Holt stages and surgical fashions and results had been analyzed. Results All 35 patients had dry ear for 2 weeks after surgery. The external auditory canals in thirteen cases（ n = 13） in stage II were completely epithelialized in 4 weeks after surgery; 7 cases in stage III with mastoidectomy（ n =7） were incompletely epitheliazed. Thirteen cases in stage III were completely epitheliazed. Stenosis had been recurred in 1 case with EAC plasty and tympanoplasty in 4 weeks after surgery. All cases had been completely epithelialized in 3 months after the surgery. Eleven patients had been followed up for one year,no recurrence occurred in these cases. Conclusion The incidence rates of cholesteatoma are varying with the change in age range. The surgical procedures are selected according to the type of temporal bone,severity of destruction and hearing level.