修正性乳突根治术相关解剖因素的CT影像分析

目的 探讨乳突根治术失败的相关解剖因素及术后复发原因,以便在修正性手术具有有针对性,提高乳突再根治手术成功率。方法 回顾性分析2008年5月—2016年4月北京同仁医院耳鼻咽喉头颈外科120例修正性乳突根治术患者的二次手术前颞骨高分辨率CT(HRCT)影像资料,并将颞骨HRCT的观察结果与再次手术中所见病变进行对比分析。结果 再手术前颞骨HRCT可以清晰显示初次开放式乳突根治术后乳突腔的大体解剖结构改变,主要征象为乳突腔扩大,与鼓室、外耳道融合,术腔内团块状异常软组织密度影。120例患者中,面神经嵴高位占39.2%(47/120),窦脑膜角残留气房占58.3%(70/120),乳突尖残留气房占50.0%(60/120),迷路周围残留气房占25.8%(31/120),上鼓室前隐窝未开放占41.7%(50/120),鼓室窦深位占40.0%(48/120),咽鼓管鼓室口病变占32.5%(39/120)。二次手术中探查乳突残留气房,咽鼓管鼓室口、鼓室窦、面神经嵴均发现有颞骨HRCT观察到的病变存在。结论 修正性乳突根治术患者术前颞骨HRCT扫描, 能够发现初次乳突根治手术后不干耳的相关解剖因素,可作为修正性乳突根治术的可靠依据。

CT imaging analysis of anatomical factors related to revision mastoidectomy

Objective To explore the anatomical factors related to the failure of mastoidectomy and to clarify the causes of recurrence of the disease after operation, so as to take targeted measures to improve the success rate of revision mastoidectomy.Methods From May 2008 to April 2016, the CT data of high resolution temporal bone in axial, coronal and oblique sagittal images of 120 patients undergoing the canal Wall down mastoidectomy in Beijing Tongren Hospital were retrospectively analyzed.The HRCT observations were compared with the lesions seen during reoperation.Results HRCT of temporal bone could clearly show the gross anatomic changes of mastoid cavity after the canal Wall down mastoidectomy. The main HRCT signs were enlargement of mastoid cavity, fusion with tympanic antrum and external auditory meatus, and abnormal soft tissue density of mass in the operative cavity. The HRCT images of axial, coronal and oblique sagittal positions in 120 patients showed that the high facial nerve ridge accounted for 39.2%(47/120). The residual cells in sinodural angle, mastoid apex, and around the labyrinth were 58.3%(70/120), 50.0%(60/120) and 25.8%(31/120) respectively. Insufficient opening for anterior epitympanic recess accounted for 41.7%(50/120) and the deep position of the sinus tympani was 40.0%(48/120). The lesion in tympanic ostium of Eustachian tube accounted for 32.5%(39/120). During the second operation, the lesions observed in the temporal bone CT were found in the residual cells of mastoid, tympanic ostium of eustachian tube, tympanic sinus and facial nerve ridge.Conclusions HRCT scan of temporal bone in patients undergoing revision mastoidectomy can find the anatomical factors of undry ear after primary mastoidectomy, which can be used as a reliable basis for revision mastoidectomy.