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目的探讨外耳道胆脂瘤(EACC)的临床特征,提高其临床诊治水平。方法回顾分析23例(24耳)患者的临床资料,对8例(9耳)骨质破坏局限于外耳道且范围小者,行耳内窥镜下清除外耳道内胆脂瘤上皮及病变组织或死骨,再局部定期清创药物治疗使其愈合。对15例胆脂瘤侵入上鼓室或乳突累及中耳者,采用耳后进路,行改良乳突根治术,病变清除后,均行外耳道成形术。结果术后外耳道口保持宽大,外耳道壁骨质薄,呈烧瓶样扩大;外耳道皮肤恢复正常,不产生上皮堆积。随访1年,无复发。结论详细的病史询问和仔细的耳内窥镜检查及颞骨CT扫描,在EACC的诊断中有着十分重要的价值。治疗原则是彻底清除胆脂瘤和死骨,防止胆脂瘤残留和复发,并根据病变程度决定手术方式。
Objective To investigate the clinical features of external auditory canal cholesteatoma (EACC) and to improve its clinical diagnosis and treatment. Methods The clinical data of 23 patients (24 ears) were retrospectively analyzed. Eight cases (9 ears) of bone destruction were confined to the external auditory canal and the range was small. Endoscopic removal of cholesteatoma epithelium and diseased tissue of the external auditory canal Bone, then local debridement drug treatment to make it healing. Of 15 cases of cholesteatoma invading the upper tympanic cavity or mastoid involvement of the middle ear, the use of posterior approach, the line of modified mastoidectomy, lesions were removed after the external auditory canal angioplasty. Results After operation, the external auditory meatus was wide and the external auditory canal wall was thin, with a flask-like enlargement. The skin of the external auditory canal returned to normal without epithelial accumulation. Follow-up 1 year, no recurrence. Conclusion Detailed medical history inquiry and careful ear endoscopy and temporal bone CT scan are of great value in the diagnosis of EACC. The principle of treatment is the complete removal of cholesteatoma and sequestrum, to prevent the residual and recurrence of cholesteatoma, and determine the surgical approach according to the degree of lesion.