外耳道胆脂瘤临床特征及治疗

目的：探讨外耳道胆脂瘤的临床特点，为手术方式的选择提供参考。方法回顾性分析2006年8月～2014年12月住院手术治疗并经病理确诊的38例（39耳）外耳道胆脂瘤患者的临床资料，总结其症状、体征、术前CT表现、临床分期、手术方式及疗效。结果所有病例外耳道均可见灰白色物或肉芽样物阻塞，术前以听力下降为主要主诉（100％，39／39），其次是耳闷涨感（79．49％，31／39）及耳痛（74．36％，29／39）。39耳外耳道胆脂瘤结合术前CT ，按 Holt分期：I期10耳，病变局限在外耳道，无骨质破坏；II期23耳，病变位于外耳道，伴骨质破坏，未累及中耳；III期6耳，病变破坏外耳道并累及中耳乳突和／或鼓室、鼓窦。I期行外耳道胆脂瘤切除术；II期行外耳道胆脂瘤切除术＋外耳道成形术和／或鼓室成形术；III期行外耳道胆脂瘤切除术＋鼓室成形术＋乳突切除术。术中见31耳鼓膜完整、内陷，8耳鼓膜松弛部穿孔，4耳听骨链砧镫关节破坏，1耳面神经垂直段裸露。所有病例均一次完成手术，听力恢复良好，无复发。结论外耳道胆脂瘤易误诊，根据临床分期选择合适手术方式可获得满意疗效。

Clinical Characteristics and Treatment of External Auditory Canal Cholesteatoma

Objective To investigate the clinical characteristics and treatment of external auditory canal chol‐esteatoma (EACC) .Methods The clinical data of 38 cases(39 ears)with external auditory canal cholesteatoma from August 2006 to December 2014 were retrospectively analyzed .Results All the cases of EACC in this study had the external ear canal full of impacted squamous material or granulation tissue .The Holt and CT imaging examinations disclosed that 10 ears were phase I ,lesions were confined to the external auditory with no bone destruction .There were 23 ears were phase II ,the lesions were located in external auditory meatus with destruction of bone ,but with no involvement of the middle ear .There were 6 ears were phase III ,showing the lesions with disrupt external audi‐tory meatus and involvement of the middle ear ( mastoid and/or tympanic sinus) .Hearing impairment and aural fullness were the most common symptoms .The phase I cases were treated by removing cholesteatomas from the ex‐ternal auditory canal .Canaloplasty and/or tympanoplasty were performed in phase II cases .The phase III cases were successfully managed by modified radical mastoidectomy and/or tympanoplasty .There were 30 ears of tympan‐ic membrane were perfect and invaginate .There were 4 ears of ossicular chain were disrupted with one ear of facial nerve exposed .All surgeries were performed at once .No recurrence except in one patient was found during the fol‐low -up period .Conclusion The clinical stages can help identify the primary lesions and determine the choice of the best surgical approach .