颞骨岩部胆脂瘤手术入路选择及疗效分析

Petrous bone cholesteatoma： surgery approach and outcomes

目的 分析总结颞骨岩部胆脂瘤的手术入路选择及手术治疗效果.方法 回顾性分析解放军总医院2000年1月至2014年12月手术治疗的90例颞骨岩部胆脂瘤病例,按Sanna方法分型：迷路上型40例,迷路下型5例,迷路下-岩尖型4例,广泛型25例,岩尖型16例.迷路上型采用经颅中窝入路31例（77.5％）,经乳突-颅中窝联合入路8例（20.0％）,经迷路入路1例（2.5％）;迷路下型5例患者均采用经乳突-迷路后入路（100.0％）;迷路下-岩尖型采用岩骨次全切除术3例（75.0％）,经迷路入路1例（25.0％）;广泛型采用岩骨次全切除术15例（60.0％）,经耳囊入路5例（20.0％）,经迷路入路4例（16.0％）,经蝶窦-岩骨次全切除术1例（4.0％）;岩尖型采用经颅中窝入路10例（62.5％）,经乳突-颅中窝联合入路3例（18.8％）,经耳囊入路2例（12.5％）,岩骨次全切除术1例（6.3％）.合计经颅中窝入路41例,乳突-颅中窝联合入路11例,岩骨次全切除19例,耳囊入路7例,迷路入路6例,乳突-迷路后入路5例,迷路-蝶窦联合入路1例.结果 术前面神经功能正常者术后面神经功能Ⅰ级保留率90％;90例中有11例术腔开放,其余术腔封闭;发生感染4例;术后脑脊液漏3例;硬膜外血肿1例;术后复发3例,均行再次手术.结论 颞骨岩部胆脂瘤可根据不同的分型采取最佳的手术入路,完整切除胆脂瘤,保护和修复面神经功能,减少复发及并发症.

Objective To investigate the choice of surgical approach of petrous bone cholesteatoma （PBC） and surgical outcomes.Methods A retrospective study was performed on 90 patients diagnosed and treated for PBC from January 2000 to December 2014 by the Chinese People＇s Liberation Army General Hospital otolaryngologists.According to Sanna＇s classification,40 out of the 90 cases were supralabyrinthine,five infralabyrinthine,four infralabyrinthine-apical,25 massive and 16 apical.Five cases underwent transmastoid and retrolabyrinthine approach,translabyrinthine approach was performed on six patients,19 cases underwent subtotal petrosectomy,seven cases underwent transotic approach,41 cases underwent middle fossa approach,combined transmastoid/middle fossa approach was performed on 11 cases,translabyrinthine and sphenoid sinus approach were performed on one case.Supralabyrinthine cases mainly applied middle fossa approach （77.5%,31/40） and combined transmastoid and middle-fossa approach （20.0%,8/40）.Combined transmastoid-retrolabyrinthine approach were applied for all the infralabyrinthine cases （100.0%,5/5）.Infralabyrinthine-apical cases mainly applied subtotal petrosectomy （75.0%,3/4）.Massive cases mainly applied subtotal petrosectomy （60.0%,15/25）,transcochlear approach （20.0%,5/25）,and translabyrinthine approach （16.0%,4/25）.Apical cases mainly applied middle fossa approach （62.5%,10/16）.Results Ninty percent （18/20） of the patients who had preoperative grade Ⅰ facial nerve function maintained in the postoperative period.Out of 90 cases,only 11 cases received open cavity,and the rest cases received cavityobliteration.There were three cases of recurrence,four cases of cavity infection,three cases of cerebrospinal fluid leakage,and one case of epidural hematoma,who all received surgeries.Conclusions Sanna＇s classification should be used to classify different kinds of PBC cases,choose the best surgical approach for different cases,and preserve or repair facial function during removal of PBC,and thus reduce recurrence and complications.