内镜下ShinⅢ期外耳道胆脂瘤手术治疗初探

Preliminary Report on Endoscopic Surgery for Shin StageⅢExternal Auditory Canal Cholesteatoma

目的初步探讨内镜下施行胆脂瘤摘除术治疗Ⅲ期(Shin分期)外耳道胆脂瘤病例的可行性及疗效。方法回顾性分析2018年1月至2018年4月我院收治的2例Ⅲ期外耳道胆脂瘤患者的临床资料,均于内镜下经外耳道行胆脂瘤摘除术。术中未行耳内切口,在0°、30°或70°等不同角度内镜直视下,利用耳显微器械逐步摘除外耳道内及侵入乳突腔内的胆脂瘤组织,操作时尽量保留外耳道上皮的完整性。出院后于门诊换药至干耳,术后每3-6月复查一次,评估干耳时间、术腔恢复情况、有无并发症及复发等。结果 2例患者均在多角度内镜下完全清除胆脂瘤,术中见这2例外耳道骨壁破坏侵犯乳突处均呈"囊袋"样突入乳突腔,上皮化均完好,未见有气房暴露。患者术后随访17-19个月,干耳时间分别为5天、7天,随访期间均无复发及并发症。结论 1、内镜下经外耳道治疗Ⅲ期外耳道胆脂瘤可安全有效清除病变,避免了传统显微镜下视野局限需开放原本完好的乳突的弊端,保留了中耳正常结构及功能。2、保留外耳道内陷上皮后,外耳道分泌物可能会局部堆积,因此术后定期于角度内镜下随访是防止复发的重要手段。

Objective To report the feasibility and efficacy of endoscopic lesion removal in patients with Shin classification StageⅢexternal auditory canal cholesteatoma.Methods Clinical data of 2 patients with Shin stageⅢexternal auditory canal cholesteatoma who were admitted to our hospital from January 2018 to April 2018 were collected.Both patients underwent endoscopic cholesteatoma removal through external auditory canal with no incision.External auditory canal cholesteatoma and the mastoid cavity were gradually removed with micro-instruments under the direct vision by endoscopy(0,30 or 70 degree angles).The external auditory canal skin was preserved.Patients received dressing exchanges until dry ear in the outpatient clinic,and were followed up every 3-6 months.Results Cholesteatoma lesions were completely removed in both patients with no air cells exposure.The epithelial lesion sacs were found intact and protruding into the mastoid.Time to dry ear was 5 and 7 days for the two patients,respectively.Neither recurrence nor complications occurred during the 17-19 months followed up.Conclusion 1.Completely endoscopic removal of Shin stageⅢexternal auditory canal cholesteatoma through ear canal is safe and effective and can avoid opening the mastoid as required in traditional microscopic approach due to limited visualization,thus preserving normal middle ear structure and function.2.Preservation of external auditory canal skin may lead to retention of secretion in the external auditory canal,requiring regular endoscopic follow-ups which are important to prevent recurrence.