中耳先天性胆脂瘤回顾研究.docVIP

中耳先天性胆脂瘤回顾研究[摘要] 目的 探讨中耳先天性胆脂瘤的诊断及预后。方法 回顾性分析9例中耳先天性胆脂瘤。结果 平均年龄为6.1岁,均有听力下降,耳镜检查见6例鼓膜后象限白色团块。8例患者术前CT发现鼓室内圆形或卵圆形软组织影。所有病例均行手术,复发率为44.4%(4/9)。随访平均7.4年,术前平均听阈28dB,术后平均听阈26dB。结论 中耳先天性胆脂瘤临床少见。单侧传导性耳聋为主要表现。术前诊断可根据Levenson诊断标准和CT检查结果。其预后和复发率与病变范围、手术方式、是否二次手术有关。 [关键词] 中耳先天性胆脂瘤;诊断;预后 [中图分类号] R739.61 [文献标识码] A[文章编号] 1673-9701(2009)34-19-03 Congenital Middle Ear Cholesteatoma:A Retrospective Analysis QIAN YiHU Guohua Department of Otorhinolaryngdogy,the First Affiliated Hospital,Chongqing Medical Unversity,Chongqing 400016,China [Abstract] Objective To investigate the location,clinical symptoms,image features,treatment and prognosis of congenital middle ear cholesteatoma. Methods A retrospective analysis was made in 9 patients with congenital middle ear cholesteatoma. Results The mean age of the patients was 6.1 years,and all the patients suffered from conductive hearing loss. The otoscopic examination showed typical cholesteatoma behind posterior tympanic membrane in 6 cases.Preoperative CT in 8 of 9 cases showed spheroid or ovoid masses in the tympanic cavities. All the patients underwent surgery,and the recurrence rate was 44.4%(4/9). All of the cases were followed up for a mean period of 5.3 years,the preoperative hearing threshold was 28dB and postoperative hearing threshold was 26dB. Conclusion Congenital middle ear cholesteatoma is a rare and hiding lesion. The typical symptom is unilateral conductive hearing loss.Preoperative diagnosis may be based on Levenson diagnostic criteria and CT imaging. The prognosis and recurrence rate are correlated with the lesion scope,surgical approach,and second operation. [Key words] Congenital middle ear cholesteatoma;Diagnosis;Prognosis 先天性胆脂瘤(congenital cholesteatoma,CC)发病率为胆脂瘤的2%～5%,近几年来发病率有增加趋势[1]。CC以颅内多见,而中耳先天性胆脂瘤(CMEC)少见,其早期表现无特异性,主要为传导性听力下降。早期诊断可降低并发症发生率。 1资料和方法 1.1一般资料 本文回顾性分析了法国斯特拉斯堡一大附属医院1987～2006年的9例儿童CMEC。9例CMEC中,均为单侧发病,男7例,女2例;年龄4～10岁,平均年龄6.1岁。所有患儿均有听力下降。耳镜检查发现鼓膜正常2例,鼓膜后象限白色团块影6例,整个鼓膜发红1例。