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1、岩骨胆脂瘤的诊断与治疗许耀东郑亿庆丁健慧区永康陈穗俊李卫红【摘要】目的探讨岩骨胆脂瘤的诊断与治疗。方法总结5例（5耳，其中2耳先天性,3耳后天性）岩骨胆脂瘤的临床表现，影像学结果及手术经验。结果5耳均有重度聋或全聋,3耳面瘫,3耳脑膜炎;颍骨CT扫描呈低密度边缘光滑的膨胀性缺损，磁共振成像（magneticresonanceimaging,MRI）屮T1加权呈屮等均一信号,T2加权呈高信号。增强扫描无强化。4（1耳先天性,3耳后天性）岩骨胆脂瘤耳采用迷路进路，1耳先天性岩骨胆脂瘤采用颅中窝-迷路联合进路手术。术后随访0•5〜4年，无脑脊液漏，未见胆
2、脂瘤复发，均获干耳。3耳而瘫患者，1例完全恢复，1例II级恢复，1例III级恢复。结论颖骨CT扫描对临床诊断具有重要作用,MRI具有鉴别诊断价值。对于无实用听力患者，迷路进路是最实用和理想的手术进路。【关键词】胆脂瘤；颍骨岩部；诊断,鉴别；耳鼻喉外科手术ThediagnosisandtrcatmentofpetrousbonecholcstcatomaXUYao-dong*,ZHENGYi-qing,DINGJian-hui,OUYong-kang,CHENSui-jun,LIWei-hong•^DepartmentofOtorhinolaryng
3、ologyHcadandNeckSurgery,SecondAffiliatedHospital,SunYat-scnUniversity,Guangzhou510120,ChinaCorrespondingauthor:XUYao-dong(Email:xuyo@gzsums.cdu.cn)[Abstract]ObjectiveTostudythediagnosisandtreatmentofpetrousbonecholesteatoma•MethodsAretrospectivcreviewwasmadein5patients(congeni
4、talin2,aquiredin3)withpetrousbonecholesteatoma•Theclinicalmanifestation，imagedataandexperienceofoperationweresummarized•ResuItsAllthe5casespresentedprofoundhearingloss•Facialparalysisoccurredin3casesandmeningitisin3cases•Intheimageofcomputedtomography(CT),thecholesteatomaisane
5、xpansivelesionwithsmoothedgeandlow-densitysignal•T1Wimageofmagncticresonance(MR)showshomogeneousmediumintcnsitysignal,whileT2Wshowshighintensitysignal,withoutcnheincementwiththecontrast•Fourpatients(onewithcongenitalandthreewithaquiredcholcsteatoma)acceptedoperationbythetrans-
6、labyrinthapproach•Thesurgerywasperformedintheotheronewithcongcniteilpctrouscholcsteatomabythecombinedapproachoftrans-middlccranialfossaandtrans-labyrinth•Duringthefollow-upperiodsof6monthsto4years,nocerebrospinalfluidleakwasfound•Therewasnorecurrenceofcholesteatoma且ndallpatien
7、tshad“dryear”•Inthe3patientswithfacialparalysis,onecasehadcompletcrecovery,onetodegreeIIandonetodegreeIIIaccordingtoBrackman-House7sgradingsystem•ConclusionCToftcmporalboneplaysanimportantroleinthediagnosisofpertrousbonecholestcatoma,whereasMRcanhelptomakeadifferentialdiagnosi
8、s•Ifthepatienthasnopracticalhearing,trans~labyrinthapproachis
