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目的探讨外耳道胆脂瘤(EACC)的临床特点,并评估其治疗效果。方法回顾性分析2015年1月至2016年12月47例(47耳)EACC的临床资料,所有患者术前接受听力学检查,耳内镜及颞骨CT检查。结果所有患者外耳道均可见黄白色鳞状或肉芽样物阻塞。耳闷胀感、耳痛及耳流脓是EACC常见症状。CT显示41耳有骨破坏。按Holt分期:47耳中,Ⅰ期6耳,Ⅱ期29耳,Ⅲ期12耳。对Ⅰ期6耳及Ⅱ期5例儿童患者行EACC和/或肉芽去除术;对24例Ⅱ期成人患者联合行胆脂瘤清除及外耳道成形术;12例Ⅲ期患者中,9例行乳突改良根治术和/或鼓室成型术,3例行乳突根治术。所有患者术后2周干耳,3个月内术腔完全上皮化。除3例行乳突根治术的患者术后听力无改善,其余44耳都有不同程度的提高。所有患者术后随访3~24个月,未见EACC复发者。结论 EACC可被误诊,骨质破坏是其最重要的特征。颞骨CT有助于EACC的分期及制定治疗方案,应根据疾病分期、患者年龄及听力水平选择手术方法。彻底清除胆脂瘤及保持外耳道宽敞是治愈该疾病及预防复发的关键。
Objective To investigate the clinical characteristics of external auditory canal cholesteatoma (EACC) and to evaluate its therapeutic effect. Methods The clinical data of 47 cases (47 ears) of EACC from January 2015 to December 2016 were retrospectively analyzed. All patients underwent preoperative audiology, endoscopic and temporal bone CT examination. Results All patients were visible in the external auditory meatus yellow-white squamous or granulomatous obstruction. Ear boredom, earache and ear pus are common symptoms of EACC. CT showed 41 ears with bone destruction. According to Holt staging: 47 ears, Ⅰ 6 ears, Ⅱ 29 ears, Ⅲ 12 ears. EACC and / or granulation excision were performed on 6 cases of stage Ⅰ and 5 cases of stage Ⅱ, and cholesteatoma removal and external auditory canal angioplasty were performed on 24 cases of stage Ⅱ adult patients. Of the 12 cases with stage Ⅲ, 9 cases received milk Suddenly modified radical mastectomy and / or tympanoplasty, 3 cases of radical mastoidectomy. All patients were treated with dry ear for 2 weeks and completely epithelialized within 3 months. Except for 3 cases of radical mastoidectomy, there was no improvement in hearing after surgery, and the remaining 44 ears had different degrees of improvement. All patients were followed up for 3 to 24 months, no recurrence of EACC. Conclusion EACC can be misdiagnosed and bone destruction is the most important feature. Temporal bone CT contributes to the staging of EACC and the development of treatment options, surgical methods should be selected according to the stage of the disease, the age of the patient and the level of hearing. Complete removal of cholesteatoma and keep the external auditory canal spacious is the key to cure the disease and prevent recurrence.