小兒膽脂瘤的手術治療

Surgical Treatments of Cholesteatoma in Children

連江豐(Ching-Feng Lien) ； 廖文輝(Wen-Huei Liao)

《中華民國耳鼻喉科醫學會雜誌》 33卷6期 (1998/12) Pp. 591-596

https://doi.org/10.6286/1998.33.6.591

摘要

背景:小兒膽脂瘤的特性，包括有侵犯快速，侵入乳突腔多，手術及術後的照顧不易。本報告乃經由14年間三種手術的方法及其聽力結果，分析並探討何種手術方法，較合小兒膽脂瘤的治療。
方法:自1981年至1995年間，有55例小兒膽脂瘤病例，採手術方式治療。其手術方法可區分為三的類群:第一類群有10例，採用保留耳道壁法。第二類群有22例，採幅真保留耳道壁及乳突腔為開放腔法。第三類群有23例，採用不保留耳道壁且乳突腔有軟骨填塞法。比較這三類群手術方法的聽力結果及其術後復發情形。
結果:採保留耳道壁法(10例):術前平均氣導閾值約為27dB，術後平均氣導閾值約為29dB，有2例復發病例。採不保留耳道壁及乳突腔為開放腔法(23例):術後平均氣導閾值約為44dB，術後平均氣導閾值約為42dB，無復發病例。而採不保留耳道壁且乳突腔有軟骨填塞法(22例);術後平均氣導閾值約47dB，術後平均氣導閾值約為41dB，且無復發病例。
結論:小兒膽脂瘤的處理情形較為特殊且困難，一般傳統的保留耳道壁法及不保留耳道壁乳突腔為開放腔法的手術方法，並不適合小兒膽脂瘤的治療。所以我們提出一種較為簡單方便且聽力結果不錯的手術方法，即是採用不保留耳道壁且乳突腔有軟骨填塞法

關鍵字

小兒膽脂瘤 ； 保留耳道壁法 ； 不保留耳道壁法 ； 軟骨填塞法

並列摘要

Background: Cholesteatoma in children have three characterisics: more extensive, faster growh rate, more difficult to handle than in adults. We analyzed three kinds of surgical treatments in order to find which method was more effective.
Methods: This retrospective study of 55 cholesteatomatous ears in 53 children aged 16 years or less, who were treated between 1981 and 1995. We classified the sugical methods into three groups: the canal wall up (CWU), the canal wall down (CWD) with open cavity, and the canal wall down (CWD) with cartilage obliteration of open cavity.
Result: The CWU gropu (10 cases): The mean post-operative hearing gain was -2 dBHL. There were 2 cases of recurrence in this group. The CWD with open cavity group (23 cases): The mean post-operative hearing gain was 2 dBHL. No recurrence in this gropu. The CWD with cartilige obliteration of open cavity group: The mean post-operative hearing gain was 6 dBHL. No recurrence in this group.
Conclusion: The CWD with cartilage obliteration of cavity surgery is the method of choice for children cholesteatoma, mainly because of better hearing results and no recurrence.

並列關鍵字

children cholesteatoma ； canal wall up ； canal wall down ； cartilage obliteration