摘要
目的 分析鼓室副神经节瘤的临床特征,总结诊治经验.方法 回顾性选取2017年6月—2021年8月在兰州大学第二医院耳鼻咽喉头颈外科接受手术治疗并经病理学证实的鼓室副神经节瘤患者15例,其中女性12例,男性3例.左耳8例,右耳6例,双耳1例.分析其临床表现、诊断过程以及治疗方法,探讨该病诊断中可能存在的问题,分析手术治疗的适应证和手术方法.结果 15例患者中耳鸣(100%)、听力下降(93.3%)、耳流脓(86.7%)为主要症状.15例16耳中11耳见外耳道内红色肿物(其中6耳肿物搏动),另外5耳见鼓膜内侧红色搏动性肿物.15例患者中,纯音测听听阈正常者2例,传导性耳聋6例,7例8耳为混合性耳聋.15例患者均行颞骨高分辨率计算机断层扫描(high-resolution computed tomography,HRCT)检查,5例行MRI检查.10例手术前临床诊断鼓室副神经节瘤,5例临床诊断为慢性化脓性中耳炎和外耳道胆脂瘤.根据影像检查和手术所见按Fisch分型,A型2例,B型13例(14耳),均经手术治疗,其中2例行耳内镜下手术切除,肿瘤全部切除.随访1～5年,肿瘤无复发.结论 鼓室副神经节瘤临床少见,对于有耳鸣和听力下降症状的中年女性,发现外耳道或鼓膜内侧红色肿物,应考虑到鼓室副神经节瘤,完善HRCT及增强MRI利于术前诊断.鼓室副神经节瘤手术疗效确切,显微镜辅助下肿瘤切除术是主要方式,耳内镜下手术将来有一定应用前景.
Abstract
Objective To report clinical features of tympanic paraganglioma and authors'experience with its di-agnosis and treatment.Methods Data from 15 patients(3 males and 12 females)with pathologically confirmed tympan-ic paraganglioma were retrospectively reviewed.The tumor was on the left in 8 cases,on the right in 6 case,and on both sides in 1 case.Potential problems in diagnosis and surgical indications and techniques were discussed.Results Tinni-tus(100%),hearing loss(93.3%)and ear discharge(86.7%)were the main symptoms.Red mass in the external auditory canal was seen in 11 of the 16 ears,with pulsation in 6 ears and red pulsatile mass behind the tympanic membrane in 5 ears.Hearing was normal in 2 cases,showing conductive deafness in 6 cases and mixed deafness in 7 cases.All patients underwent HRCT and five patients also underwent MRI.Tympanic paraganglioma were diagnosed clinically in 10 cas-es.In 5 cases it was misdiagnosed as chronic suppurative otitis media and cholesteatoma of external auditory canal.Ac-cording to the Fisch classification,the lesion was type A in 2 case and type B in 13 cases(14 ears).All tumors were completely surgically resected with no recurrence during the 1-5 years follow-ups.Conclusion Tympanic paraganglio-ma is a rare disease,but should be suspected in a middle-aged women with tinnitus,hearing loss,red mass in the exter-nal auditory canal or behind the tympanic membrane.HRCT and enhanced MRI are beneficial in diagnosis.Surgical re-moval is effective,with microscopic approach being the mainstream for middle ear paraganglioma.With the develop-ment of technology,resection via a transcanal endoscopic approach starts to show certain application prospects in the fu-ture.
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