III型外耳道胆脂瘤手术治疗的术式选择

目的　探讨骨性外耳道后壁和乳突遭不同程度破坏的III型外耳道胆脂瘤的治疗选择及疗效。方法　收集44例（共45耳）临床诊断为III型外耳道胆脂瘤患者，根据乳突破坏程度的不同采用不同的术式进行手术：27耳乳突破坏未达鼓窦患者（A组），采用单纯乳突修理+外耳道成形术+必要时行耳甲腔成形术治疗；18耳乳突破坏达鼓窦患者（B组），采用乳突切开+乳突填充+外耳道成形+耳甲腔成形术治疗。结果　所有患者术后随访1～2年，均无胆脂瘤复发，无外耳道塌陷、狭窄或闭锁，听力有不同程度的提高。其中A组患者术后干耳率为100%，平均干耳时间（12.1±2.3）d，具有光滑外耳道以及良好自净作用的占100%；B组患者术后干耳率为94.4%，平均干耳时间（28.1±3.5）d，具有光滑外耳道以及良好自净作用的占88.9%。结论　III型外耳道胆脂瘤可根据乳突破坏是否达鼓窦而采用不同的术式：破坏未达鼓窦患者，采用单纯乳突修理+外耳道成形术+必要时行耳甲腔成形术；破坏达鼓窦患者，采用乳突切开+乳突填充+外耳道成形+耳甲腔成形术，疗效均显著。

Choice of surgical treatment for type III external auditory canal cholesteatoma

ABSTRACT]OBJECTIVETo investigate the treatment choice and curative effect of stage III external auditory canal cholesteatoma (EACC) with different degrees of damage to the posterior wall of external auditory canal and mastoid.METHODS44 patients (45 ears) diagnosed with III type external auditory canal cholesteatoma and treated with different surgeries were collected: 27 ears with damages of mastoid which did not involve tympanic antrum (group A) underwent simple mastoid repair+external auditory canal plasty+conchoplasty (in necessity). 18 ears with damages of mastoid which involve the tympanic antrum (group B) underwent mastoidectomy+mastoid filling+external auditory canal plasty+conchoplasty. RESULTSAll patients were followed up for 1 to 2 years postoperatively. There was no recurrence of cholesteatoma, no external auditory canal collapse, stricture or atresia,and hearing improved to different degrees. The postoperative dry ear rate of group A and group B was 100% and 94.4% respectively. The mean duration of dry ear in group A and B was (12.1±2.3) and (28.1±3.5) days respectively. The cases with smooth external auditory canal and good self-purification in group Aand B accounted for 100% and 88.9%respectively.CONCLUSIONType III external auditory canal cholesteatoma can be treated with different surgical methods according to different damages of mastoid. The cases in which damages of mastoid did not involve tympanic antrum can be treated with simple mastoid repair+external auditory canal plasty+conchoplasty (in necessity). The cases in which damages of mastoid involved tympanic antrum can be treated with mastoidectomy+mastoid filling+external auditory canal plasty+conchoplasty.