- 期刊
乳突孤立術－上鼓室膽脂瘤的新治療法
Mastoid Isolation - A New Surgical Technique for Attic Cholesteatoma
摘要
背景：對於價限於上鼓室膽脂瘤的手術，一般有兩種方法：一為開放式，即磨開乳突竇和上鼓室，合併有或沒有肌肉骨膜瓣填塞。另一為封閉式，磨開上鼓室外側壁，再以軟體重建上鼓室外側壁（即鼓室頂部成形術）。但開放式會有腔洞問題；封閉式可能於術後的數年因軟骨的吸收、不穩固而造成凹陷袋再形成。本科擬思在這兩種手術方法以外，再發展出另一手術方法，可徹底清除膽脂瘤，又可避免術後再形成凹陷袋。 方法：自1989年6月至1997年2月，完成21例上鼓室膽脂瘤手術。這些病例皆施予室頂部切開術完整清除膽脂瘤，其中第1組10例施予鼓室頂部成形術合併鼓室成形術；另第2組11例施予乳突孤立術合併鼓室成形術。術後追蹤統計2組別之純音聽力及傷口癒合情形。 結果：第1組有1例於後來產生再發性膽脂瘤往上鼓室上方發展，1例發生耳膜內陷沾粘。第2組11例術後傷口癒後情形均良好，無耳膜塌陷、沾黏、耳漏或復發性膽脂瘤等情形。2組之氣導聽力增益無明顯差異。 結論：對上鼓室膽脂瘤，施予鼓室頂部切開術，然後完整清除膽脂瘤合併乳突孤立術，是值得推薦的手術方法。
並列摘要
Background: In handling attic cholesteatoma, there are two different tech-niques usually applied. One is the open method in which the mastoid antrum and attic are opened with or without obliteration using a musculope-riosteal flap. The other is the closed method in which the lateral attic wall is removed and reconstructed with cartilage. Both methods may have some shortcomings. The open method usually results in a cavity problem. The closed method, on the other hand, may lead to retraction pocket formation because of resorption of the cartilage after several years. In order to remove a cholesteatoma completely and avoid the formation of a retraction pocket after surgery, an alternative surgical technique of mastoid isolation has been designed. Methods: From June 1989 through February 1997, 21 patients received operations for attic cholesteatoma. Atticotomy was performed to remove the cholesteatoma. For the reconstruction of the attic defect, 10 patients received scutumplasty combined with tympanoplasty (ST) and 11 patients underwent mastoid isolation combined with tympanoplasty (MIT). All patients were followed for an average period of 14 months. Results: In the ST group, two patients developed complications. On had a recurrent cholesteatoma at the superior attic area and the other developed adhesion of the eardrum. In the MIT group, all healed well without recurrent cholesteatoma, otorrhea, atelectasis, or adhesion of the eardrum. There were no differences in hearing gains between the two groups. Conclusions: In treating attic cholesteatoma, atticotomy for pathology removal combined with the mastoid isolation technique for attic reconstruct-tion is a promising method.