38例岩尖胆脂瘤临床诊疗分析

发布时间：2018-01-02 09:40

本文关键词：38例岩尖胆脂瘤临床诊疗分析　出处：《临床耳鼻咽喉头颈外科杂志》2015年02期 　论文类型：期刊论文

【摘要】：目的:探讨岩尖胆脂瘤的临床特点、诊断方法以及治疗策略。方法:对我科收治的38例岩尖胆脂瘤患者的临床表现、诊断方法以及手术治疗进行回顾性分析。结果:138例患者中,33例患者术前均有不同程度的单侧听力下降及面瘫,其中27例先出现听力下降,后出现面神经麻痹,6例发病初期以面瘫为主要表现;217例患者伴有持续性高调耳鸣,4例伴有剧烈耳痛,15例伴有眩晕;3所有患者高分辨率CT均可见岩尖骨质破坏,同时MRI提示岩尖存在占位性改变;4术中彻底清除病变,12例患者行颅中窝进路行胆脂瘤切除术,23例患者行迷路-耳蜗入路,3例在鼻内镜下行岩尖胆脂瘤切除术,7例行面神经端端吻合术,8例患者行面神经减压术,11例行面神经-舌下神经吻合术,3例行耳大神经移植术,随访1~2年,未见复发。结论:岩尖胆脂瘤的临床表现无明显特异性,高分辨率CT及MRI在岩尖胆脂瘤诊断中具有重要价值,应根据胆脂瘤的分类、部位以及患者听力、面神经功能选择最佳的手术治疗策略。
[Abstract]:Objective: To investigate the clinical characteristics of petrous apex cholesteatoma, diagnostic methods and treatment strategies. Methods: the clinical manifestations of 38 cases of petrous apex cholesteatoma patients admitted to our department, diagnostic methods and surgical treatment were analyzed retrospectively. Results: among 138 patients, 33 patients had no unilateral hearing loss and the same degree of paralysis the first, of which 27 cases occurred after the onset of hearing loss, facial nerve paralysis, 6 cases of early onset of facial paralysis as the main performance; 217 cases of patients with persistent high tinnitus, 4 cases with severe earache, 15 cases with vertigo; all 3 patients with high resolution CT demonstrated petrous bone destruction, while MRI indicates the presence of the petrous apex occupying changes; 4 patients in the complete removal of the lesion, 12 cases of patients with the middle cranial fossa approach for resection of cholesteatoma, 23 cases of patients with cochlear labyrinthectomy approach, 3 cases of endoscopic resection of petrous apex cholesteatoma, 7 cases of facial nerve anastomosis Surgery, 8 cases of patients with facial nerve decompression, 11 cases of facial hypoglossal nerve anastomosis, 3 cases of great auricular nerve transplantation, follow-up 1~2 years, no recurrence was found. Conclusion: the clinical manifestation of petrous apex cholesteatoma had no obvious specificity, high resolution CT and MRI has important value in the diagnosis of petrous apex cholesteatoma should be. According to the classification and position of patients with cholesteatoma, hearing and facial nerve function selection strategy for optimal surgical treatment.

【作者单位】：解放军总医院耳鼻咽喉头颈外科解放军耳鼻咽喉研究所聋病教育部重点实验室;
【分类号】：R764.9
【正文快照】： 岩尖胆脂瘤是颞骨岩尖鳞状上皮的进行性病理损害,占岩尖病变的4%~9%,病变包绕神经和血管,形态不规则,边缘多比较光滑,呈膨胀性生长,具有见缝就钻的特点〔1〕。岩尖胆脂瘤由于其解剖位置较深,早期症状较难发现,容易发生误诊和漏诊;同时,由于其毗邻重要区域、血管以及神经,大大

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