论文部分内容阅读
患者,女,35岁,反复右耳流脓10年,略带臭味,间歇时间短,反复药物治疗不愈,伴有轻度听力下降,偶有低音调耳鸣.以“右耳慢性肉芽性鼓膜炎,右慢性中耳炎可能”于1997年3月21日收治入院.体检:右鼓膜充血,后下方见“肉芽”状物,鼓膜未见明显穿孔,鼓膜表面少量脓性分泌物.纯音测听言语频率平均听阈为:右耳气导18 dB HL、气骨导差11 dB HL,左耳气导20 dB HL.手术显微镜下示:右耳鼓膜完整,“肉芽”呈小颗粒状,但质较韧,范围3mm×4mm.术中将病灶并周边部鼓膜上皮一起仔细剥除,保留鼓膜纤维层,取耳轮脚皮肤植于创面上.术后病理报告“鼓膜表皮乳头状瘤”.(见附图)二周后取出耳道填塞物,创面未全上皮化,但平整,听力良好,出院,嘱门诊随访.三月后因右耳再次少量流黄水入院,发现原创面后缘处有单个“肉芽”.再次钳除“肉芽”,创面再次植皮.二周后干耳,鼓膜上皮化,听力良好.病理检查为“少量鳞状上皮及纤维组织”未发现肿瘤复发,出院.局限于鼓膜乳头状瘤病极罕见,我们检索了近15
Patients, female, 35 years old, repeated right ear pus for 10 years, slightly smelly, intermittent time is short, repeated drug treatment unhealed, accompanied by mild hearing loss, occasional low pitch tinnitus. “Right ear chronic granulation Tympanitis, right chronic otitis media may be admitted to hospital on March 21, 1997. Physical examination: right tympanic membrane hyperemia, see ”granulation“ below the bottom, no obvious perforation of the tympanic membrane, tympanic surface a small amount of purulent secretions. The average audiometric thresholds were: 18 dB HL for the right ear, 11 dB HL for the air conduction, and 20 dB HL for the left ear. The operating ear microscope showed a right ear eardrum intact and a ”granulation“ More tough, the scope of 3mm × 4mm. Surgery will be the lesion and the surrounding tympanic membrane epithelium together carefully removed, keep the tympanic membrane layer, take the ear wheel skin implanted in the wound.Postoperative pathology report ”Tympanum papilloma.“ (See Figure) Remove the ear canal stuffing after two weeks, the wound is not full of epithelialization, but the formation of a good hearing, discharged, ordered outpatient follow-up .After a small amount of yellow water in the right ear again after admission and found that the origin of the trailing edge A single ”granulation.“ Once again clamp the ”granulation“, the wound skin graft again. Two weeks after the dry ear, tympanic membrane epithelialization, hearing Good.Pathological examination for ”a small amount of squamous epithelium and fibrous tissue" found no tumor recurrence, discharge.Confidential to the tympanoderma disease is extremely rare, we searched for nearly 15