继发性获得性胆脂瘤临床分析

宋勇莉; 陈俊; 温立婷; 乔燕; 张婵娟; 陈阳; 查定军; 邱建华

doi:10.13201/j.issn.1001-1781.2018.18.005

继发性获得性胆脂瘤临床分析

- 空军军医大学西京医院耳鼻咽喉头颈外科(西安, 710032)

详细信息

通讯作者: 陈阳,E-mail:782385212@qq.com

中图分类号: R764.2

收稿日期: 2018-07-24

The study for the characteristics of secondary acquired cholesteatoma

- Department of Otolaryngology Head and Neck Surgery, the Air Force Military Medical University, Xijing Hospital, Xi'an, 710032, China

More Information

Corresponding author: CHEN Yang, E-mail: 782385212@qq.com

Received Date: 24 July 2018

摘要

摘要: 目的：探讨继发性获得性胆脂瘤（SAC）的临床特征及预后。方法：18例行手术治疗并确诊为SAC的患者，对所有患者性别、年龄、病程、术前干耳情况、鼓膜穿孔大小、上皮移行分类、上皮移行的位置、听骨链破坏、硬化灶、鼓膜张肌腱受累、胆脂瘤分级（JOS，2015日本）、乳突气化程度分级（JOS，2015日本）、术前气导听阈、骨导听阈、气骨导差及术后患者鼓膜愈合及听力改善情况进行分析。结果：18例SAC患者中，术前未干耳14例，干耳4例；所有患者均为紧张部中央型穿孔，其中近全穿孔5例，大穿孔10例，中等穿孔2例，小穿孔1例；听骨链完整5例，听骨链破坏13例（其中锤骨受累6例，砧骨受累12例，镫骨受累4例）；鼓膜张肌腱受累13例；合并鼓膜或鼓室内硬化灶9例；上皮移行源自锤骨柄14例，穿孔边缘3例，砧骨长脚1例；上皮向前上移行3例，后上移行3例，前上和后上移行12例；胆脂瘤分级Ⅰ级11例，Ⅱ级7例；乳突气化MC0 6例，MC1 10例，MC2 2例。术后随访3~16个月，所有患者鼓膜均完整，无胆脂瘤复发，术后气导听阈（43.02±14.96）dB较术前（56.32±10.15）dB显著降低（P<0.05），气骨导差（21.04±12.90）dB较术前（35.56±9.84）dB显著缩小，差异有统计学意义（P<0.05）。结论：SAC在临床上相对少见，多继发于鼓膜紧张部大穿孔或近全穿孔，病程较长，术前常不能干耳，上皮主要经锤骨柄移行，其次是穿孔边缘，可向前上或后上移行，常伴有鼓膜张肌腱及听骨链受累，乳突气化不良及鼓室硬化灶形成等，其临床特点不同于其他类型的胆脂瘤，需进一步研究其临床病程进展及病理过程。
- 中耳炎 /
- 继发性获得性胆脂瘤 /
- 上皮
Abstract: Objective: Retrospctive analysed the Characteristics and outcomes of surgical treatment of 18 patients who were diagnosed as secondary acquired cholesteatoma (SAC).Method: Patients with SAC accepted operations were enrolled in this study. Then the factors such as sex, age, cource of history, otorrhea before operation, the size of perforation of tympanic membrane, entry site of epithelium, extension direction, ossicular destruction, tympanosclerosis, tympanum tympani tendon involvement, stage of cholesteatoma(JOS, 2015, Japan),degree of gasification of mastoid(JOS,2015,Japan),air conductive threshold, bone conductive threshold, air-bone gap, the healing of tympanic membrane and the auditory improvement were analyzed.Result: Eighteen patients were enrolled in this study, with course of history range from 2 months to 50 years (average:20.20±16.31) years. There were 14 cases with wet ear before operation. All patients were conformed with perforation of membranal tensa by otoendoscopic photography before operation, with nearly total in 5 ears,large size in 10 ears,medium size in 2 ears and small size in 1 ear. Ossicular erosion were found in 13 patients (malleus involved in 6, incus involved in 12 and stapes involved in 4). Thirteen patients with tendon of tensor tympani involved and 9 patients with tympanosclerosis were conformed during operation. The epithelium entered through the malleus manubrium to the promontory in 13 cases, through the edge of the perforation in 3 cases and through the incus long process to around stapes in 1 case. Cholesteatoma invasion extend to anterosuperior area in 3 cases, posterosuperior area in 3 cases,both in anterosuperior and posterosuperior area in 12 cases. The cholesteatomas classified:stage Ⅰ in 11 cases, stage Ⅱ in 7 cases. Mastoid gasification classified MC0 in 6 cases, MC1 in 10 cases and MC2 in 2 cases. The average air conductive threshold was (56.32±10.15) dB, bone conductive threshold was (20.76±6.22) dB and air-bone gap (35.56±9.84) dB.Tympanic membrane healed in all patients during following up, without recurrent of cholesteatoma, and the post-operative air conductive threshold (43.02±14.96) dB and air-bone gap (21.04±12.90)dB were improved significantly(P<0.05).Conclusion: Most of SAC were secondary to nearly total or large perforation of membranal tensa (83.33%), with relative long history of chronic otitis media (average 20.20 ±16.31) years and otorrhea before operation. The epithelium entered mainly through the malleus manubrium to the promontory,then through edge of the perforation,by extending anterosuperior and posterosuperior area and usually accompanied with tendon of tensor tympani involved, ossicular destruction, and poor mastoid gasification and tympanosclerosis. The characteristics of SAC were different from other type of cholesteatoma which need further researches.
- otitis media /
- secondary acquired cholesteatoma /
- epithelium

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