中耳胆固醇肉芽肿手术治疗策略探讨

目的:探讨中耳胆固醇肉芽肿手术治疗的策略。方法:对19例中耳胆固醇肉芽肿患者的临床资料进行回顾性分析。其中4例行单纯鼓膜置管术,8例行完壁式乳突切除+后鼓室切开+鼓膜置管术,7例行开放式乳突切除+鼓膜置管术。结果:术后随访0.5～3.3年。4例行单纯鼓膜置管术的患儿中,2例术后复发;8例行完壁式乳突切除+后鼓室切开+鼓膜置管术的患者中,3例术后复发;7例行开放式乳突切除+鼓膜置管术的患者无一例复发。在目前情况良好的14例患者中,有12例患者听力较术前明显改善。结论:对初发、病变范围局限的青少年患者,术前应完善检查以排除咽鼓管机械性阻塞因素,可选择单纯鼓膜置管术,术后定期观察;对症状反复发作、单纯置管或完壁式乳突切除+后鼓室切开+鼓膜置管术无效、病程较长或病变范围广泛的患者,应选择做保留鼓室完整性的开放式乳突切除+鼓膜置管术。

The investigation of the strategy of surgical treatment of cholesterol granuloma in the middle ear

Objective:To investigate the surgical treatment of cholesterol granuloma in middle ear.Method:Nineteen patients of cholesterol granuloma in middle ear were retrospectively study.All the patients were treated with tympanic tube insertion,canal wall up mastoidectomy or intact-tympanic canal wall down mastoidectomy respectively.Result:All the cases were followed up from 6 months to 3.3 years.Two patients recurred among the 4 patients treated with tympanic tube insertion,3 patients recurred among 8 patients treated with canal wall up mastoidectomy,and no recurrence was found among 7 patients treated with intact-tympanic canal wall down mastoidectomy.12 patients had their hearing improved obviously among 14 patients without recurrence.Conclusion:For the juvenile patients with a short medical history occurred for the first time,tympanic tube insertion merely is a reasonable choice after the factor of obstruction of the pharyngotympanic tube was removed.For the patients with a long medical history and comprehensive lesions,or occurred repeatedly after being treated with tympanic tube insertion or canal wall up mastoidectomy,the intact-tympanic canal wall down mastoidectomy should be a good choice.