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首页> 外文期刊>The American journal of otology >Petrosal cholesteatoma: management considerations for minimizing morbidity.
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Petrosal cholesteatoma: management considerations for minimizing morbidity.

机译：石油性胆脂瘤：最小化发病率的管理考虑。

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OBJECTIVE: This study aimed to analyze the surgical treatment of patients presenting with petrosal cholesteatoma. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at a tertiary referral center. PATIENTS: Patients were referred to the University Department of Otolaryngology, Manchester Royal Infirmary, with surgically confirmed petrosal cholesteatoma. INTERVENTION: Interventions were diagnostic and therapeutic. MAIN OUTCOME MEASURES: Postoperative facial function, hearing loss, recurrent cholesteatoma, and petrous cavity morbidity in relation to preoperative signs, intraoperative findings, and surgical techniques were measured. RESULTS: Twenty-five patients were treated between 1979 and 1997. Complete preoperative facial paralysis was always associated with bony erosion around the geniculate ganglion, and facial nerve ischemia was thought to be an important factor. Resection of the ischemic nerve segment and end-to-end anastomosis over the posterior fossa dura allowed full removal of cholesteatoma matrix and reinnervation along a healthy and vascularized nerve. In five of the seven cases with recurrent disease, cholesteatoma was localized to the intrapetrous carotid or geniculate ganglion. The introduction of endoscopic techniques has allowed assessment of the full extent of disease and removal of cholesteatoma matrix missed using conventional microscopic visualization. Bipolar diathermy to areas of cholesteatoma, densely adherent to dura, is effective in destroying squamous epithelium. Patients with cavity obliteration and blind sac closure had minimal postoperative morbidity, and current magnetic resonance imaging techniques are effective in diagnosing and delineating recurrence. CONCLUSIONS: This study illustrates a gradual change in the treatment of patients with petrosal cholesteatoma. By defining the main areas of patient morbidity and using both recent technical advances and alternative surgical techniques, further improvement in patient outcome is envisaged.
机译：目的：本研究旨在分析伴有石油性胆脂瘤的患者的手术治疗。研究设计：研究设计是回顾性病例回顾。地点：该研究是在三级转诊中心进行的。患者：患者被转诊至曼彻斯特皇家医院的耳鼻咽喉科，并经手术证实患有岩性胆脂瘤。干预：干预是诊断性和治疗性的。主要观察指标：测量与手术前体征，术中发现和手术技术有关的术后面部功能，听力丧失，胆脂瘤复发和石腔并发症。结果：1979年至1997年期间治疗了25例患者。术前面部完全麻痹总是与膝状神经节周围的骨质侵蚀有关，而面部神经缺血被认为是重要的因素。切除后颅硬脑膜的缺血性神经节段和端对端吻合可以完全清除胆脂瘤基质，并沿着一条健康的血管神经再支配神经。在7例复发性疾病中，有5例胆脂瘤局限于颈内或颈内神经节。内窥镜技术的引入已允许评估疾病的全部范围，以及使用常规的显微镜可视化技术清除遗漏的胆脂瘤基质。胆脂瘤高密度附着于硬脑膜的区域的双极透热疗法可有效破坏鳞状上皮。患有腔闭塞和盲囊闭合的患者术后发病率极低，并且当前的磁共振成像技术可有效地诊断和确定复发。结论：本研究说明了在治疗石油性胆脂瘤患者中的逐步改变。通过定义患者发病率的主要领域，并利用最新的技术进步和替代性手术技术，可以设想进一步改善患者的预后。

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