32例颞骨岩部胆脂瘤的临床分析

Clinical analysis of 32 patients with temporal petrous bone cholesteatoma

摘要:

目的 总结分析颞骨岩部胆脂瘤的临床资料，探讨不同类型岩部胆脂瘤的诊疗策略。方法 回顾性分析32例颞骨岩部胆脂瘤，按Sanna分型分为迷路上型(10例)、迷路下型(11例)、迷路下-岩尖型(1例)、巨大迷路型(9例)、岩尖型(1例)，根据不同情况选择不同手术方式。评估面瘫情况：术前面瘫10例(31.25%)，面瘫HB分级Ⅱ级1例，Ⅲ级1例，Ⅳ级2例，Ⅴ级2例，Ⅵ级4例。术前即伴颅内外并发症者21例，其中脑脓肿5例。归纳总结各类岩部胆脂瘤的治疗经验。结果 32例颞骨岩部胆脂瘤患者均行手术治疗，无死亡病例。以彻底切除胆脂瘤为前提，其中1例巨大迷路型胆脂瘤，病变侵及桥小脑角区，术中残留少许，其他患者在显微镜下或内镜下观察均无病变残留。术后新增的并发症有Bezold脓肿1例、额颞顶枕部硬膜下血肿1例、脑脊液耳漏1例、术后面瘫3例，均予以相应治疗后痊愈。术后随访6~36个月，其中有迷路上型1例复发，巨大迷路型1例复发，并再次行手术治疗痊愈，随访中无死亡病例。结论 颞骨岩部胆脂瘤的治疗，术式选择至关重要，需根据病变分型、面神经功能及并发症等综合评估，在彻底清除病变的前提下，并保留面神经功能、重建听力及处理并发症。

关键词:岩部胆脂瘤;面神经;脑脓肿;乙状窦血栓性静脉炎

Abstract:

Objective To summarize and analyze the clinical data of petrous cholesteatoma of temporal bone, and to explore the diagnosis and treatment strategy of different types of petrous cholesteatoma.Methods Thirty-two cases of petrous cholestatoma of temporal bone were retrospectively analyzed. According to the Sanna classification, the 32 patients were divided into superior labyrinthous type (10 cases), inferior labyrinthous type (11 cases), inferior labyrinthy-petrous apex type (1 case), giant labyrinthous type (9 cases) and petrous apex type (1 case).Different surgical methods are selected according to different the conditions of patients.Evaluation of facial paralysis: 10 cases (31.25%) of the patients had facial paralysis before operation.HB classification of facial paralysis included 1 case of grade Ⅱ, 1 case of grade Ⅲ, 2 cases of grade Ⅳ, 2 cases of grade Ⅴ and 4 cases of grade Ⅵ. There were 21 cases with intracranial and extracranial complications before operation, including 5 cases with brain abscess.To summarize the treatment experience of various types of petrous cholesteatoma.Results None of the 32 patients with petrous bone cholesteatoma died after surgical treatment.On the premise of complete resection of cholesteatoma, one case of huge labyrinthiform cholesteatoma invaded the pontocerebellar angle area with a little residual during operation. The other cases showed no residual lesions under microscope or endoscope.The new complications included Bezold abscess in 1 case, frontotemporoparietal occipital subdural hematoma in 1 case, cerebrospinal fluid otorrhea in 1 case, and postoperative facial paralysis in 3 cases, all of which were cured after corresponding treatment. After 6 to 36 months of follow-up, there was one recurrence of superlabyrinthian type and one recurrence of giant labyrinthal type,who were operated again.There were no deaths during follow-up.Conclusions The selection of surgical strategies and surgical methods for petrous bone cholestatoma was very important, which should be comprehensively evaluated according to the classification of lesions, facial nerve function and complications, etc.Under complete removal of lesions and reduced complications,the function of facial nerve and hearing were preserved.

Key words:Petrous bone cholesteatoma;Facial nerve;Brain abscess;Thrombophlebitis of sigmoid sinus