累及乳突的外耳道胆脂瘤手术方式

Surgical approach for external auditory canal cholesteatoma

目的探讨累及乳突的外耳道胆脂瘤手术方式的选择以及术中外耳道后壁保留的适应证、处理方法及意义。方法回顾性分析2015~2018年收治我院耳科病房的外耳道胆脂瘤患者139例(147耳)。每例患者均接受保留或不保留外耳道后壁的乳突根治术。结果根据胆脂瘤侵犯范围采取不同的手术方式,胆脂瘤清除同时行外耳道后壁修补术71耳,完壁式乳突根治术62耳,开放式乳突根治术14耳。术后均达到干耳。比较手术前后气导平均阈值(t=18.99,P=0.03)及骨导平均阈值(t=6.48,P=0.01)均有明显下降。术后随访1~2.5年,未见胆脂瘤复发。结论外耳道胆脂瘤治疗应依据病变侵袭范围,采取不同的手术方式,只要胆脂瘤没有广泛累及乳突,都应尽量保留外耳道后壁完整性,采用完壁式乳突根治术,达到术后良好的治疗效果和长久的干耳状态。

OBJECTIVE To explore the optimal operative approach for external auditory canal cholesteatoma and to analyze the indications, surgical procedures and significance of preserving the canal. METHODS 139 patients including 147 ears with the diagnosis of external auditory canal cholesteatoma were retrospectively evaluated. Each case accepted a mastoidectomy either preserving or not preserving the external canal wall. RESULTS Different surgical procedures were performed according to the invading extent. 71 ears accepted treatment of lesions removal along with the canal wall reconstruction. 62 ears accepted canal wall-up mastoidectomy. The other 14 ears accepted canal wall-down mastoidectomy. All the patients enjoyed a dry-ear status. The average threshold of air conduction(t=18.99, P=0.03) and bone conduction(t=6.4,P=0.01) were significantly improved. The postoperative follow-up was 1-2.5 years with no relapse. CONCLUSION Treatment for external auditory canal cholesteatoma should be considered based on the extent of lesions. As long as there were no extensive cholesteatomas in the mastoid process, the integrity of posterior external canal wall should be preserved with canal wall-up mastoidectomy. It will achieve a better outcome with longer dry-ear status.