Ⅱ-Ⅳ型外耳道胆脂瘤临床特征及手术治疗

Clinical characteristics and surgical treatment of types Ⅱ to Ⅳ external auditory canal cholesteatoma

目的：探讨Ⅱ~Ⅳ型外耳道胆脂瘤的临床特征、诊断方法、手术方式及效果。方法：63例Ⅱ~Ⅳ型外耳道胆脂瘤患者中,Ⅱ型39例,Ⅲ型22例,Ⅴ型2例。在显微镜下摘除胆脂瘤的同时行外耳道成形术或鼓室成形术或改良乳突根治术。结果：2例术后外耳道狭窄,2例胆脂瘤复发,再次手术后治愈;4例由于听骨链破坏严重,术后听力无明显变化。其余患者一次性手术治愈,术腔上皮化好,未见胆脂瘤复发。结论：颞骨CT检查在胆脂瘤的诊断及分型中具有重要意义。预防和早期诊断尤其重要。应根据胆脂瘤的类型、部位以及患者的听力情况制定适宜的治疗方案。手术应彻底清除病变,根据情况重建听力。

Objective：The aim of this study is to explore the clinical characteristics,diagnostic methods,surgical procedures and results of typesⅡ to Ⅳexternal auditory canal cholesteatoma.Method：In the 63 cases,there were 39 patients suffering typeⅡexternal auditory canal cholesteatoma,22 patients suffering type Ⅲ and 2 patients suffering typeⅤ.All patients had surgeries to remove the lesion under the microscope,and underwent canaloplasty or tympanoplasty or modified mastoidectomy as well.Result：There were 2 cases occurred meatal stenosis postoperatively,as well as 2 cases of cholesteatoma recurrenced,and were cured after second operation.Four patients＇ hearing level were not improve postoperatively due to the severe damage of their ossicular chain.All other patients were cured with one operation,which the cavity with good skin coverage and there has been no recurrence.Conclusion：Temporal bone CT scan has important significance in the diagnosis and classification of external auditory canal cholesteatoma.Prevention and early diagnosis are particularly important.Surgical treatment should completely remove the lesion,restore hearing according to the situation,and appropriate surgical treatment should be taken according to the classification,location of external auditory canal cholesteatoma as well as hearing level of patients.