中耳胆固醇肉芽肿手术治疗效果分析

陈俊; 张域开; 温立婷; 韩宇; 刘珍珍; 陈阳; 邱建华; 查定军

doi:10.13201/j.issn.2096-7993.2020.10.006

中耳胆固醇肉芽肿手术治疗效果分析

- 1.
  空军军医大学西京医院耳鼻咽喉头颈外科(西安，710032)
- 2.
  陆军第83集团军医院眼耳鼻喉科

详细信息

通讯作者: 查定军，E-mail：zhadjun@fmmu.edu.cn

中图分类号: R764.2

收稿日期: 2020-04-05

刊出日期: 2020-10-05

Analysis of surgical effect on middle ear cholesterol granuloma

- 1.
  Department of Otorhinolaryngology Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
- 2.
  Department of Ophthalmology and Otorhinlaryngology, Hospital of the 83rd Group Army of the People's Liberation Army

More Information

Corresponding author: ZHA Dingjun, E-mail: zhadjun@fmmu.edu.cn

Received Date: 05 April 2020

Publish Date: 05 October 2020

摘要

摘要: 目的探讨中耳胆固醇肉芽肿(CG)手术方式的选择, 并评估其治疗效果。方法对手术治疗的66例中耳CG患者进行回顾性研究。根据病史、耳内镜、纯音听阈和颞骨CT确定手术方式。单纯鼓膜置管术12例, 完壁式乳突切开+鼓室成形+鼓膜置管术40例, 开放式乳突切开+鼓室成形+鼓膜置管术14例。检测手术前后纯音听阈的变化, 并比较分析500、1000、2000、4000 Hz这4个频率的平均气骨导差(ABG)。结果 1例单纯鼓膜置管术后出现通气管堵塞, 另1例单纯鼓膜置管术后CG复发; 1例完壁式乳突切开术取出通气管后出现分泌性中耳炎。单纯鼓膜置管术组手术前后ABG分别为(21.25±5.96) dB和(8.85±6.49) dB, 完壁式乳突切开+鼓室成形+鼓膜置管术组分别为(34.19±10.43) dB和(23.55±12.48) dB, 开放式乳突切开+鼓室成形+鼓膜置管术组分别为(36.43±12.11) dB和(25.71±13.50) dB, 3组术后平均ABG较术前均有显著改善(P < 0.01)。结论中耳CG的手术治疗应遵循彻底清除病变、解除阻塞、通畅引流的原则, 结合患者病情采用个性化的手术方式, 术后应坚持长期随访。
- 中耳 /
- 胆固醇肉芽肿 /
- 外科手术 /
- 回顾性研究
Abstract: Objective To evaluate surgical effects on middle ear cholesterol granuloma(CG).Method The patients receiving surgery due to middle ear CG were retrospectively analyzed. The choice of operative methods was made according to medical history, endotoscope, pure-tone audiometry and temporal bone CT. Tympanostomy tube(TT) insertion was performed on 12 patients; canal wall up(CWU) tympanoplasty combined with tympanostomy tube was performed on 40 patients, and canal wall down(CWD) tympanoplasty combined with TT on 14 cases. The pre-and postoperative audiometric results(500, 1000, 2000 and 4000 Hz) were evaluated for each patient. Then the average air-bone gap(ABG) was analyzed.Result One patient had postoperative tube obstruction. One patient who performed only TT insertion recurred. Secretory otitis media occurred in one case undergoing CWU tympanoplasty after removal of the ventilation tube. For TT insertion group, pre-and postoperative ABG levels were (21.25±5.96) dB and (8.85±6.49) dB, respectively(P < 0.01). For CWU+TT group, pre-and postoperative ABG levels were (34.19±10.43) dB and (23.55±12.48) dB, respectively(P < 0.01). For CWD+TT group, pre-and postoperative ABG levels were (36.43±12.11) dB and (25.71±13.50) dB, respectively(P < 0.01).Conclusion The aim of surgical treatment for middle ear CG includes thorough removal of lesions, improvement of ventilation and drainage of middle ear. Individualized surgical strategy should be adopted according to the patients' conditions. And long-term follow-up should be done after operation.
- middle ear /
- cholesterol granuloma /
- surgical procedures, operative /
- retrospective studies

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图 1 耳内镜所见

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图 2 颞骨轴位CT

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图 3 术中所见

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表 1 3种术式手术前后平均ABG的变化 dB，x±s

术式	例数	术前	术后	t	P
单纯鼓膜置管术	12	21.25±5.96	8.85±6.49	7.736	< 0.001
完壁式乳突切开+鼓室成形+鼓膜置管术	40	34.19±10.43	23.55±12.48	13.23	< 0.001
开放式乳突切开+鼓室成形+鼓膜置管术	14	36.43±12.11	25.71±13.50	11.19	< 0.001

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参考文献(13)

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