一期手术清除胆脂瘤并发迷路瘘的疗效分析

Therapeutic effect of one-stage resection of cholesteatoma complicated with labyrinth fistula

目的探索一期手术清除胆脂瘤并发迷路瘘的手术方法,评估一期手术清除胆脂瘤基质后的远期听力变化和手术疗效。方法选取2014年8月—2019年8月收治的41例胆脂瘤并发迷路瘘患者,术前仔细询问症状,均行瘘管试验、耳内镜检查、纯音测听检查和高分辨率颞骨薄层CT检查提示有胆脂瘤并发迷路瘘。41例迷路瘘管覆盖的胆脂瘤基质进行一期完全切除。分析术后听力改善情况与瘘管大小的关系,评估各种诊断检查的准确性。结果根据术前检查结合术中探查发现,12例为外耳道胆脂瘤并发迷路瘘,29例为中耳胆脂瘤并发迷路瘘。所有患者术后3个月复查骨导阈值(BC)(42.1±12.8)dB与术前BC(35.5±11.6)dB比较无显著性差异(P>0.05)。术后5例患者骨导听力下降>10 dB,其中3例为术前平均气导阈值(AC)>90 dB。术前检查听力明显下降的5例患者,术中探查发现瘘管明显大于无听力损失的患者(P<0.05)。随访12~72个月,无复发病例。结论虽然大迷路瘘全部切除胆脂瘤基质风险较大,但为了减少胆脂瘤复发及术后听力继续下降,选择一期完全切除胆脂瘤基质是治疗迷路瘘安全有效的方法。

Objective To explore the surgical method for one-stage removal of cholesteatoma complicated with labyrinthine fistula,and evaluate the long-term hearing changes and therapeutic effect.Methods Clinical data of 41 cases suffering from cholesteatoma complicated with labyrinthine fistula surgically treated in our department from Aug 2014 to Aug 2019 were analyzed retrospectively.The diagnosis of cholesteatoma complicated with labyrinthine fistula was preoperatively confirmed by careful history taking,fistula test,endotoscopic examination,pure tone audiometry and high-resolution thin slice CT of temporal bone.One-stage complete removal of cholesteatoma stroma covered by labyrinthine fistula was performed in all 41 cases.The relationships between hearing changes at the postoperative visit and long-term hearing changes and the size of the fistula were analyzed,and the accuracies of various diagnostic tests were evaluated.Results Preoperative examination and intraoperative exploration revealed external auditory canal cholesteatoma complicated with labyrinth fistula in 12 cases,and middle ear cholesteatoma complicated with labyrinth fistula in 29.The difference between the preoperative bone conduction threshold(35.5±11.6)dB and that at the postoperative visit(42.1±12.8)dB was statistically insignificant(P>0.05).Of 5 cases with postoperative bone conduction hearing loss more than 10 dB,the preoperative average air conduction threshold was greater than 90 dB in 3.In 5 cases with obvious preoperative hearing loss,the fistulae were intraoperatively found to be significantly larger than those without hearing loss(P<0.05).Postoperative follow-up for 12 to 72 months revealed recurrence in none.Conclusion Although the total removal of cholesteatoma stroma of large labyrinth fistula is relatively risky,it is safe and effective to choose one-stage complete resection of cholesteatoma stroma in order to reduce the recurrence of cholesteatoma and the continued hearing loss after surgery.