中耳胆固醇肉芽肿并发胆脂瘤的回顾性分析

目的 探讨中耳胆固醇肉芽肿并发胆脂瘤的病因、发病机制及二者间的相互关系，并就该病的诊断及治疗方法进行讨论。方法 采用回顾性研究，总结分析我院1988年3月－2000年5月经手术和病理诊断证实的63例中耳胆固醇肉芽肿患者中并发胆脂瘤15例患者的临床资料。结果 15例患者均有较长时间的病史，除不同的程度的听力下降外，皆有耳溢然，其中脓血性及血性耳溢液8例；均有鼓膜穿孔，其中松弛部穿孔10例。11例颞骨CT扫描者均报告为胆脂瘤型中耳炎。15例皆行手术治疗，术中发现胆固醇肉芽肿与胆脂瘤交错存在，胆固醇肉芽肿多好发于鼓窦、上鼓室及乳突腔，6例乳突气化良好者气房内有咖啡色粘液蓄积，并有闪烁发亮的点状胆固醇结晶。12例出现鼓窦扩大、上鼓室外侧壁破坏、听骨链侵蚀、鼓室天盖及面神经水平段暴露等骨质破坏。6例咽鼓管鼓口、15例鼓峡阻塞。所有病例术后均干耳，12例行鼓室成形术者11例术后听力有不同程度的提高。结论 中耳胆固醇肉芽肿与胆脂瘤的病理生理改变有共同之处，即均有通气受阻、引流障碍，二者可能为同一致病因素引起的两个不同且相互作用的病理过程。对慢性中耳炎患者出现不 明原因的血性耳溢液者应想到本病可能，应结合CT、磁共振成像（magnetic resonance imaging,MRI)提高术前诊断率。治疗应根据病变部位、范围和程度不同采取不同的术式，其原则是彻底清除病变、通畅引流。

A retrospective study on cholesteatoma otitis media coexisted with cholesterol granuloma]

OBJECTIVE: To investigate the etiology and pathogenesis of cholesteatoma otitis media accompanied by cholesterol granuloma and the relationship between cholesteatoma and cholesterol granuloma. METHODS: Sixty three cases of middle ear cholesterol granuloma treated in our hospital during the period from March 1988 to May 2000 were retrospectively reviewed. All cases were verified by surgery and pathology. Fifteen cases of cholesteatoma coexisted with cholesterol granuloma were found among the 63 patients. RESULTS: All fifteen cases had a long-term history of otitis media, such as otorrhea (sanguine purulent otorrhea and bloody otorrhea in 8 cases) and perforation of the ear drum (perforation of pars flaccida in 8 cases). Temporal bone CT scans showed cholesteatoma in 11 cases. All patients were treated surgically, and cholesteatoma and cholesterol granuloma were found coexisting alternatively, and the latter lied mainly in the tympanic antrum, attic and mastoid air cells. Chocolate-colored mucus was accumulated in well-developed mastoid air cells, and glistening dotty cholesterol crystals were also found. In most cases, enlarged aditus, destruction of lateral attic wall, erosion of ossicular chain, exposition of horizontal segment of facial nerve and tegmen of attic were found. Occlusion of Eustachian tube was found in 6 cases, and occlusion of tympanic isthmus was found in all cases. A post-operative dry ear was obtained, and hearing improved in all 12 cases following tympanoplasty. CONCLUSIONS: Cholesteatoma and cholesteatoma granuloma in middle ear may share a common pathophysiological etiology, an occlusion of ventilation and a disturbance of drainage. The diagnosis should be considered when patients with chronic otitis media presented with bloody otorrhea. CT and magnetic resonance imaging(MRI) are useful for the diagnosis before operation. The surgical approach depends on the location, extension and severity of the lesion, and the principle of surgery is to clear the lesion and create an adequate drainage.