膽脂瘤接受乳突鑿開術後的修正手術

Revision Surgery for Cholesteatoma After Mastoidectomy

莊永龍(Yung-Lung Chuang) ； 林鴻清(Hung-Ching Lin)徐銘燦(Min-Tsan Hsu) ； 楊政謙(Cheng-Chien Yang) ； 陳昱君(Yu-Chun Chen)

《台灣耳鼻喉頭頸外科雜誌》 47卷4期 (2012/12) Pp. 330-335

https://doi.org/10.6286/2012.47.4.330

摘要

背景：膽脂瘤病人接受乳突鑿開術手術後，可能因膽脂瘤殘存或復發以及反覆性的耳漏、耳痛等問題而需再度手術。本研究在探討需施行膽脂瘤修正手術的原因，並檢視修正手術中的發現、處理方式及術後追蹤的成果。方法：以回朔研究方式，收集2005年1月至2011年6月間，因膽脂瘤之前曾接受乳突鑿開手術治療，但因膽脂瘤殘存或復發、持續耳分泌物、耳痛等原因，而在本院接受修正手術的患者作為研究對象。研究內容包括性別、年齡、症狀、理學檢查、耳部細菌培養、之前的手術方式、修正手術治療方式及治療結果。結果：共有28名病人，男女比是19：9，患者最小為5歲，最大的為79歲，平均年齡為39.8歲。右耳16例，左耳12例。症狀上以耳漏佔最多，有22例（79%）。之前的手術方式，開放式乳突鑿開術（canal wall down）有13例（46%），而封閉式乳突鑿開術（canal wall up）有15例（54%）。手術發現方面，復發或殘存性膽脂瘤有13例，其它的發現還有高顏面神經脊（high facial ridge）8例，中耳腔黏膜裸露5例等。結論：需進行修正式手術的原因，在封閉式手術是因膽脂瘤殘存和復發，開放式手術是因高顏面神經脊、乳突腔氣房沒有清理好，中耳腔黏膜裸露問題。修正手術以開放式乳突鑿開手術居多，將中耳及乳突腔變得乾燥且不易發炎。

關鍵字

膽脂瘤 ； 修正式手術 ； 乳突鑿開手術 ； 高顏面神經脊

並列摘要

BACKGROUND: Some patients with previous history of cholesteatoma surgery still have problems of residual or recurrent cholesteatoma, otorrhea, or otalgia, resulting in revision surgery. This study is to investigate the reasons for revision surgery, analyze the operation findings, research current surgical procedures and survey the outcome of revision surgery.METHODS: The cases with previous cholesteatoma surgery done between January 2005 and June 2011 were retrospectively reviewed. Clinical data including sex, age, symptoms, physical examination, ear culture, previous surgery methods, intraoperative findings, current surgical procedures and postoperative findings were investigated.RESULTS: The 28 patients included in our study were aged from 5 years to 79 years, with a median age of 39.8. Otorrhea was the most common complaint (79%). Revision mastoidectomies were applied to 13 previous canal wall down mastoidectomies and 15 previous canal wall up mastoidectomies. As for operation findings, causes of failure of previous ear surgery in the order of frequency were recurrence or residual cholesteatoma (13 cases), high facial ridge (8 cases), middle ear mucosa exposure (5 cases).CONCLUSIONS: Revision surgery was necessary in previous canal up surgery due to residual and recurrent cholesteatoma. It was necessary in previous canal down surgery because of high facial ridge, residual mastoid air cell, and middle ear mucosa exposure. Most of the operation methods in revision surgery are canal wall down mastoidectomies. Revision surgery was successful in converting middle ears and mastoid cavities into dry, infection-resistant ears.

並列關鍵字

cholesteatoma ； revision surgery ； mastoidectomy ； high facial ridge