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摘要: 目的:通过分析总结颞骨岩部胆脂瘤(PBC)的手术策略,探讨不同面神经功能状态的保护及重建方法。方法:回顾性分析28例住院手术治疗的PBC患者临床资料,按照Sanna分类标准确定手术策略,总结面神经处理方法及术后面神经功能的恢复情况。结果:采取手术治疗的PBC患者28例,分为四型:迷路上型11例,其中3例经迷路径路,行部分半规管切除,5例经耳囊径路切除病变,保留面神经骨桥,3例经耳蜗径路切除;广泛型10例,其中2例经耳囊径路切除,8例经耳蜗径路切除;4例为迷路下型,均行岩骨次全切除术;3例为迷路下-岩尖型,其中2例行颞下窝B型手术切除,另1例经耳蜗径路切除。本组未发现孤立岩尖型病例。本研究涉及面神经手术者共14例(50%),面神经减压2例,面神经移位或部分移位2例,面神经改道吻合者2例,面神经耳大神经移植修复者3例,二期面神经舌下神经吻合者2例,另有3例因面神经长期坏死,面部肌肉萎缩,建议行远期面瘫游离血管肌肉移植,但均未接受。面神经积极处理后功能改善率为71.43%,随访未见复发病例。结论:PBC主要的治疗方式是彻底手术清除,制定合理的手术策略至关重要,面神经功能的保护优于听力,积极合理的面神经处理有利于面神经功能恢复。Abstract: Objective:To discuss the therapeutic scheme of petrous bone cholesteatoma (PBC) and the technique of facial nerve reconstruction.Method:The data of 28patients who underwent surgery for PBC in our center were analyzed retrospectively.All patients were diagnosed radiologically with PBCs and reconfirmed pathologically after surgery.The surgical approach was discussed basing Sanna's classification of PBCs, and the facial nerve outcomes were analyzed moreover.Result:PBC cases 11were supralabyrinthine, 4infralabyrinthine, 3infralabyrinthine-apical, 10massive and none apical.The facial nerve was involved in 50%of the cases.The translabyrinthine approach were used in 3cases.The transotic approach was used in 7cases in this series.The transcochlear approach type was applied in 12cases.The Infratemporal fossa type B approach and subtotal petrosectomy were employed in 2cases and 4cases respectively.Active management of the nerve (rerouting, anastomosis, or grafting) was required in 14cases, postoperative facial nerve function were inproved in 10cases (71.43%).Conclusion:The appropriate surgery approach was vitally important to radical disease clearance in PBCs.The facial nerve preservation was preceded hearing preservation.Active facial nerve management were beneficial to facial nerve recovery.
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Key words:
- cholesteatoma /
- facial nerve /
- surgery
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