23例炎性迷路瘘管的手术治疗

Surgical treatment of inflammatory labyrinthine fistulae 23 cases

目的:总结炎性迷路瘘管的手术治疗经验。方法:回顾分析手术修复迷路瘘管23例的临床资料。均清除胆脂瘤基质及瘘管周围炎性病变,<2 mm的瘘管7例单用筋膜覆盖;2～3 mm的瘘管13例用小骨片填塞,外盖筋膜;>3 mm的3例瘘管用筋膜填塞瘘管两端骨管腔内,以骨片及筋膜填塞瘘管。结果:23例中,术后2例失访,余21例平均随访2.5年,19例干耳,17例眩晕消失;除术前2例全聋外,19例术后语频气导69.1 dB HL,骨导30.6 dB HL。结论:除瘘管试验外,术前岩骨轴位CT扫描有重要诊断价值。由于上下迷路之间的解剖屏障和炎性分隔,手术封闭迷路瘘管是可行的。手术成功关键是精湛的耳显微手术技巧,彻底清除病灶,可靠封闭或填塞瘘管,辅以抗炎及类固醇治疗,坚持术后治理。

Objective:To report the experience of surgical treatment of inflammatory labyrinthine fistula(LF). Method: Twenty-three patients with cholesteatomatous otitis media complicated with LF underwent mastoidecto-my, surgical repair and obliteration of LF. After removal of cholesteatoma matrix and inflammatory lesion around fistula, the fistulae were treated as following procedures: fistulae less than 2 mm in diameter were overlaid with fascia (7 cases), those 2 to 3 mm were obliterated with bone chips and fascia (13 cases) , and for those more than 3 mm, the bony semicircular canal lumen were packed with fascia and bone chips, then overlaid with fascia. Result: In 23 patients with LF, which included 22 lateral semicircular canal fistulae (SCF) and one lateral combined with posterior SCF, two patients lost follow-up and 21 cases were observed with an average follow-up period of 2. 5 years. In this series of cases, vertigo disappeared in 17 and diminished in 2. With the exception of total deafness in two cases, the average auditory thresholds in speech frequencies remained unchanged, showing that the thresholds of air conduction (AC) and bone conduction (BC) were 67. 1 dB HL and 37. 1 dB HL prior operation versus 69. 1 dB HL and 30. 6 dB HL after operation, respectively. Conclusion: Because of structural barrier between superior and inferior labyrinth and inflammatory adhesions, surgical treatment of inflammatory LF is feasible and effective. Successful operation depends on excellent microsurgery skill, complete removal of inflammatory lesion, precise obliteration of fistula, post-operative administration of antibiotics and steroids and close follow-up. In addition to fistula test, axial petrous bone CT scan is a good complemental method in preoperative diagnosis of LF.