双镜联合治疗不同分型外耳道胆脂瘤的手术效果

Surgical effect of dual mirror combined treatment for different types of external auditory canal cholesteatoma

摘要:

目的 探讨耳内镜和显微镜双镜联合治疗不同分型外耳道胆脂瘤（EACC）的手术效果和预后。方法 回顾性分析2020年1月－2022年1月该院收治并行手术治疗的32例EACC患者的临床资料，依据颞骨高分辨率CT显示的病变部位、范围和EACC分型，将纳入患者分为4型。依据病变的程度和范围，采用不同手术方法清除病变，重建传音结构。结果 术后各型平均气导分别为（20.5±4.6）、（22.3±4.2）、（44.2±3.3）和（45.7±5.4）dB HL，气骨导差分别为（12.4±3.5）、（16.5±4.7）、（19.9±7.8）和（21.5±6.3）dB HL。术后随访发现1例出现鼓膜穿孔，2例出现外耳道狭窄，2例耳硬化症；1例咽鼓管功能障碍，均经积极治疗后痊愈。结论 依据颞骨CT显示的病变范围，双镜联合可彻底清除不同分型的EACC病变，降低复发率，重建传音结构，提高患者生活质量，临床效果好。

Abstract:

Objective To investigate the effect and prognosis of surgical treatment of external auditory canal cholesteatoma (EACC) with different types under combined otoscopic-microscopic double-scope.Methods The clinical data of 32 patients with EACC underwent surgical treatment from January 2020 to January 2022 were retrospectively analyzed and classified into four types based on the lesion site and extent revealed by high-resolution CT of the temporal. Based on the EACC types, different surgical methods were used to remove the lesion and reconstructed the sound transmission structure.Results The mean postoperative air conduction for each type were (20.5 ± 4.6), (22.3 ± 4.2), (44.2 ± 3.3) and (45.7 ± 5.4) dB HL respectively, the difference in air bone gap were (12.4 ± 3.5), (16.5 ± 4.7), (19.9 ± 7.8) and (21.5 ± 6.3) dB HL. Postoperative follow-up revealed one case of tympanic membrane perforation, two cases of external auditory canal stenosis, 2 cases of otosclerosis and one case of eustachian tube dysfunction were found, which were cured after active treatment.Conclusion According to the lesion range displayed by temporal bone CT, under the combination of dual mirrors, different types of EACC lesions can be completely cleared, the recurrence rate can be reduced, the sound transmission structure can be reconstructed, and the patient's quality of life can be improved. The clinical effect is good.