保留外耳道后壁上鼓室切开软骨重建术治疗中耳胆脂瘤

摘要

Objective To report the curative effect of the epitympanoplasty with cartilage obliteration in the treatment of middle ear cholesteatoma .Methods This study retrospectively analysed 123 cases ,with middle ear cholesteatoma treated in our department from November 2009 to July 2012 .The operation included mastoidectomy with posterior canal wall preserved ,lateral wall of attic resected ,facial recess opened to the epitympanum ,epitym-panum obliterated with cartilage and mastoid cavity blocked with bone dust .All cases were followed up on complica-tions and hearing improvement .Results All cases were followed up 6~38 months .In 123 cases ,there were 2 ca-ses had cholesteatoma recurrence in the middle ear cavity ,6 cases had infection of post auricular incision after opera-tion ,3 cases had residual marginal tympanic membrane perforation ,2 cases had ossicular replacement prosthesis ex-clusion ,and 6 cases had canal wall skin swelling or defect .The rest cases acquired full -recovery after 2 or 3 wound dressing changes .Out of 123 cases ,83 cases had the whole hearing document ,the average AB gap at 0 .5 ,1 ,2 kHz reduced from 32 .2 ± 11 .2 dB pre-operation to 20 .7 ± 12 .4 dB post -operation .The AB gap of pre - and post -operation had significant difference (P<0 .001) .Conclusion The mastoidectomy with posterior canal wall preserved greatly shortened the healing time .The resection of lateral wall of epitympanum can exposed operating field more completely and remove lesions thoroughly .The cartilage obliteration in the attic can prevent the retraction pocket formation effectively .This technique provides alternative in treating middle ear cholesteatoma .%目的探讨在保持外耳道后壁完整的情况下，切除上鼓室外侧壁并软骨封闭治疗中耳胆脂瘤的疗效。方法2009年11月～2012年7月对123例（123耳）中耳胆脂瘤患者行保留外耳道后壁的乳突切开、上鼓室盾板切除及面神经隐窝向上鼓室开放，清除病变后行上鼓室软骨封闭及乳突腔填塞术，术后随访6～38个月，观察胆脂瘤复发、上鼓室回缩袋形成情况及听力提高水平，分析其疗效。结果123例中，2例中耳腔胆脂瘤复发，6例术后耳后切口感染，3例鼓膜边缘穿孔延迟愈合，2例人工听骨脱出，4例术后耳道后壁肿胀或皮肤缺损，其余病例术后换药2～3次后鼓膜、外耳道形态恢复，痊愈时间1个月。听力资料完整的83例（67．5％，83/123）中，0．5、1、2 kHz气骨导差术前平均32．2±11．25 dB ，术后平均20．69±12．41 dB ，手术前后气骨导差缩小11．59±10．1 dB（P＜0．001）。结论乳突切开同时保留外耳道后壁使耳道形态得以保留，术后恢复时间短；切除上鼓室外侧壁能够更充分暴露病变，病灶清除彻底；上鼓室外侧壁软骨封闭重建可有效防止回缩袋的形成，避免胆脂瘤复发。