放疗后中耳胆固醇肉芽肿的治疗.docVIP

放疗后中耳胆固醇肉芽肿的治疗 　　作者：杨海弟,许耀东,张志钢,陈穗俊,郑　　作者单位：中山大学孙逸仙纪念医院耳鼻喉科 　　【摘要】 【目的】 研究放疗后中耳胆固醇肉芽肿行乳突根治及鼓室成型术手术的效果【方法】 对在我科确诊为鼻咽癌放疗后中耳胆固醇肉芽肿的9例患者9耳进行手术治疗研究,放疗与手术间隔时间为6 ~ 14年(平均9年),术前接受的放射剂量为68~75 Gy?所有患耳采取的手术治疗方法包括开放乳突根治或完壁乳突根治术,同时行鼓室成型,其中3例行开放乳突根治+鼓室成型;6例行完壁乳突根治+鼓室成型?【结果】 所有患者术后均随访2年以上,7耳鼓膜完整(占77.8%),2耳在术后3个月出现鼓膜再穿孔,但耳流脓?耳闷塞感明显较术前减少?平均纯音听阈PTA和A-B Gap分别由术前的90.5 dB和45.8 dB 改善至术后6个月的62.3dB和25.5 dB?【结论】 大多数鼻咽癌放疗后中耳胆固醇肉芽肿患者可采取手术改善症状,放疗引起的慢性中耳炎不是鼓室成型的禁忌证? 　　【关键词】 放射治疗;中耳胆固醇肉芽肿;手术 　　Abstract: 【Objective】 To evaluate the surgical outcome of mastoidectomy plus tympanoplasty for cholesterin granuloma of the middle ear in post-irradiated patients. 【Methods】 Nine ears diagnosed cholesterin granuloma in the middle ear in post-irradiated NPC patients were included in this study. The time from radiotherapy termination to surgery ranged from 6 to 14 years (median 9 years). All the patients with NPC received radiotherapy of 68 to 75 Gy before surgery. All patients underwent radical tympanoplasty plus mastoidectomy with canal wall down or up. Three ears underwent canal wall down mastoidectomy plus tympanoplasty and six ears underwent canal wall up mastoidectomy plus tympanoplasty. 【Results】 All the patients were followed up for 2 years at least. There were 7 ears (77.8%) had intact tympanic membrane and 2 ears developed reperforation of eardrum 3 months after surgery, but otorrhea decreased significantly. All these patients reported improved quality of daily life after the surgery. The pure tone average (PTA) of pre-operation was 90.5 dB and air-bone gap (A-B gap) was 45.8 dB respectively versus 62.3 dB and 25.5 dB postoperation 6 months. 【Conclusion】 Most of post-irradiated NPC patients with cholesterin granuloma of the middle ear benefit from the surgery. Chronic otitis media caused by radiotherapy is not a contraindication to tympanoplasty. 　　Key words: radiotherapy; cholesterin granuloma of middle ear; surgery 　　以往多数临床医生对翼状胬肉的术前评估往往关注的多是泪液功能[1-2]?侵犯角膜的长度[3]等,并认为这些泪液功能等对翼