岩骨胆脂瘤的诊断与治疗.docVIP

岩骨胆脂瘤的诊断与治疗许耀东　郑亿庆　丁健慧　区永康　陈穗俊　李卫红【摘要】　目的　探讨岩骨胆脂瘤的诊断与治疗。方法　总结5例(5耳,其中2耳先天性,3耳后天性)岩骨胆脂瘤的临床表现,影像学结果及手术经验。结果　5耳均有重度聋或全聋,3耳面瘫,3耳脑膜炎;颞骨CT扫描呈低密度边缘光滑的膨胀性缺损,磁共振成像(magnetic resonance imaging,MRI)中T1加权呈中等均一信号,T2加权呈高信号。增强扫描无强化。4(1耳先天性,3耳后天性)岩骨胆脂瘤耳采用迷路进路,1耳先天性岩骨胆脂瘤采用颅中窝-迷路联合进路手术。术后随访0·5~4年,无脑脊液漏,未见胆脂瘤复发,均获干耳。3耳面瘫患者,1例完全恢复,1例级恢复,1例级恢复。结论　颞骨CT扫描对临床诊断具有重要作用,MRI具有鉴别诊断价值。对于无实用听力患者,迷路进路是最实用和理想的手术进路。【关键词】　胆脂瘤;　颞骨岩部;　诊断,鉴别;　耳鼻喉外科手术The diagnosis and treatment of petrous bone cholesteatoma　XU Yao-dong*, ZHENG Yi-qing,DING Jian-hui,OU Yong-kang,CHEN Sui-jun,LI Wei-hong·*Department of OtorhinolaryngologyHead andNeck Surgery, Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510120 ,ChinaCorresponding author:XU Yao-dong (Email:xuyo@gzsums.edu.cn)【Abstract】　Objective　To study the diagnosis and treatment of petrous bone cholesteatoma·Methods　A retrospective review was made in 5 patients (congenital in 2, aquired in 3) with petrous bone cholesteatoma·The clinical manifestation, image data and experience of operation were summarized·Results　All the 5 cases presented profound hearing loss·Facial paralysis occurred in 3 cases and meningitis in 3 cases·In the image of computed tomography (CT), the cholesteatoma is an expansive lesion with smooth edge and low-density signal·T1W image of magnetic resonance (MR) shows homogeneous mediumintensity signal, while T2W shows high intensity signal, without enhancement with the contrast·Four patients (one with congenital and three with aquired cholesteatoma) accepted operation by the trans-labyrinth approach·The surgery was performed in the other one with congenital petrous cholesteatoma by the combined approach of trans-middle cranial fossa and trans-labyrinth·During the follow-up periods of 6 months to 4 years, no cerebrospinal fluid leak was found·There was no recurrence of cholesteatoma and all patients had“dry ear”·In the 3 patients with facial paralysis, one case had complete recovery, one to degreeⅡand one to degreeⅢaccording to Brac