颞骨先天性胆脂瘤的诊断和治疗

发布时间：2018-03-21 12:49

本文选题：先天性　切入点：胆脂瘤　出处：《中华耳科学杂志》2014年03期 　论文类型：期刊论文

【摘要】：目的分析总结颞骨先天性胆脂瘤的病变部位、范围、大小、临床表现、影像学资料、诊断、鉴别诊断及手术经验,包括受损面神经恢复情况。方法回顾性分析1999年1月至2013年4月诊治的10例颞骨先天性胆脂瘤患者的临床资料和诊治规律。结果 10例颞骨先天性胆脂瘤患者中,年龄为1~57岁,男7例,女3例,其中患耳为左侧5例,右侧5例。病变位于乳突区6例,其中1例患者外耳道后壁受累破坏;病变累及乳突区、岩尖4例,术前出现面瘫,面神经骨管均已破坏、裸露,其中1例术中出现脑脊液漏,予同期行脑脊液漏修补术。本组均采取手术治疗的方式,9例行改良开放式乳突根治术,其中1例术中同期行面神经减压+鼓室成形术;1例为人工耳蜗植入患者同期行闭合式乳突凿开鼓室成形术,同期植入人工耳蜗电极,术后语训恢复良好。所有病例术后1年复查CT等没有发现胆脂瘤残留或复发。结论对先天性胆脂瘤通过病史、听力学、影像学资料等进行鉴别诊断,可以做到早期诊断,并选择合适的手术入路。特别是对于岩部先天性胆脂瘤,在出现面瘫等并发症,及时通过CT、MRI等影像学资料,做到早期诊断、早期治疗,可能会避免误诊和漏诊。
[Abstract]:Objective to analyze and summarize the location, scope, size, clinical manifestation, imaging data, diagnosis, differential diagnosis and surgical experience of congenital cholesteatoma of temporal bone. Methods the clinical data, diagnosis and treatment of 10 patients with congenital cholesteatoma of temporal bone were retrospectively analyzed from January 1999 to April 2013. Results the age of 10 patients with congenital cholesteatoma of temporal bone was 1 to 57 years old. There were 7 males and 3 females, of whom 5 were left and 5 were right. The lesions were located in the mastoid region in 6 cases, in which 1 case was involved in the posterior wall of the external auditory canal, 4 cases were involved in the mastoid area, 4 cases were involved in the petrosal apex, and the facial palsy occurred before operation. The facial nerve bone canal had been destroyed and exposed. One case of cerebrospinal fluid leakage occurred during the operation, and the repair of cerebrospinal fluid leakage was performed at the same time. 9 cases of this group were treated by surgical treatment and 9 cases were treated with modified open mastoidectomy. One case underwent decompression tympanoplasty of facial nerve and one case underwent closed mastoid chiseling tympanoplasty and cochlear electrode implantation simultaneously. The recovery of postoperative speech training was good. Ct examination in all cases 1 year after operation showed no residual or recurrence of cholesteatoma. Conclusion early diagnosis of congenital cholesteatoma can be achieved by differential diagnosis of congenital cholesteatoma through history, audiology, imaging data, etc. Especially for congenital cholesteatoma of petrosal region, if complications such as facial paralysis occur, the early diagnosis and treatment may avoid misdiagnosis and missed diagnosis.
【作者单位】：福建医科大学附属第一医院耳鼻咽喉头颈外科;
【分类号】：R764.9

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