后天原发性中耳胆脂瘤(附180例分析)

本文总结后天原发性中耳胆脂瘤180例。与同期住院之继发性胆脂瘤之比,约1:4。耳漏和听力减退是两个基本症状。耳漏分为微量性,间歇发作性和持续流脓性。松弛部小穿孔,听骨链完好者,听力图呈轻度传导性耳聋,骨导正常。听骨链破坏者呈中等度以上传导性耳聋,平均气骨差30db。发现外耳道后上壁塌陷有两种情况:一是大胆脂瘤自乳突穿破了外耳道后壁,二是上鼓室胆脂瘤破坏了部分上鼓室外壁,自鼓切迹处穿出。提出本病应分为Ⅴ期两个阶段,即Ⅰ、前上皮病期, Ⅱ、上鼓室豉窦胆脂瘤期,Ⅲ、乳突胆脂瘤期,Ⅳ、后鼓室胆脂瘤期,Ⅴ、合并症期。每期可有两个阶段即稳定阶段和急性感染阶段。180例中发生各科并发症30例占16.6%。与国内各家比较,发生率较低。认为与病例纯属后天原发性胆脂瘤有关。为论证此点,将同期住院的所有胆脂瘤并发症,分两组比较,统计经过X~2处理,证明颅内并发症和耳后脓瘘在继发性胆脂瘤中,有更高的发生率。认为本病的许多临床特点,包括并发症发生率低,与胆脂瘤发展过程造成中,上鼓室不通这种特殊病理状态有关。治疗以上鼓室鼓窦开放术和改良乳突根治术为主,仅少数作了乳突根治术。未发生任何手术并发症,1例颞叶脑脓肿死亡,余全治愈。术后远期干耳率为64%。

Primary Acquired Cholesteatoma(analysis of 180 cases)

180 cases of primary acquired cholesteatoma are discussed in thisreport. The proportion of primary and secondary acquired cholesteatoma ofin-patients during the same period of time was 1:4. Otorrhea and hearingloss were the two fundamental symptoms of the diseage. Otorrhea may beminor, intermittent, or continuous. Patients with a small perforation in thepars flaccida and a perfect auditory ossicle chain usually have a mildconductive deafness as shown in audiogramm. A moderate or more seriousconductive deafness often occurs in the cases with destroyed auditory ossicles. A fall in the post-superior wall of the external auditory can befound under two conditions: one is the cholesteatoma passing through theposterior wall of the external auditory canal from the mastoid, the otheris the attic cholesteatoma passing through the incisura tympanic from thedestroyed laternal bone wall of the attic. Primary acquiredc holesteatoma can be classified into five stages: 1 ) astage of anterior epithelium; 2 )a stage of attic tympanic cholesteatoma; 3 )astage of mastoid cholesteatoma; 4 ) a stage of posterior tympanic choleste-atoma; and 5 ) a stage of complications. Each stage has two phases, i. e. asteady and an acute infective phases. 30 of the 180 cases(16. 6%)had various kinds of complications. Comparedwith other reports published in our country, the reoccurence of complicationsis low. Many clinical features and characteristics of the disease, including thelow frequency rate of complications, depend on the block of the path bet-ween the attic and meso-tympanum, which occurs in the course of the deve-lopment of cholesteatoma. Atticectomy and modified radical mastoidectomyare the essential methods for treatment. Radical mastoidectomy was performedonly in a few cases. All patients recovered except one who died of a brainabcess in the tampral lobe. According to the result of the fallow-up, thepostoperative dry-ear rate is 64%.