CAJ | 학술논문

　　目的探讨儿童外耳道胆脂瘤的临床特点、早期诊断和治疗方法。方法分析我院2007年1月～2009年12月21例4～12岁外耳道胆脂瘤患者的临床和影像学特征及术中所见。手术方法：10例病变局限并能配合的儿童采用门诊清除病变；11例全麻下手术。结果21例均以患耳疼痛、流脓或有血性渗液就诊。检查发现外耳道流脓或血性渗液17例；有黄白色发亮或灰白色团块状物12例；外耳道肿胀8例；有肉芽5例；CT检查21例均见外耳道软组织样影,12例外耳道内段扩大；外耳道骨质呈锯齿状破坏7例；鼓室盾板破坏4例；鼓膜內移8例；侵入上鼓室3例，乳突腔1例。术中见13例外耳道骨部皮肤不同程度缺损；10例鼓膜后上部上皮受损；2例鼓膜紧张部穿孔；3例鼓膜松弛部穿孔。21例均随访6个月-2年未见复发。结论外耳道胆脂瘤常侵犯外耳道皮肤、鼓膜、骨质及中耳，甚至发生其它严重并发症，早期症状隐匿，多在耳痛或感染时发现，应早期发现并及时彻底清除病变，以减少并发症发生。
　　목적탐토인동외이도담지류적림상특점、조기진단화치료방법。방법분석아원2007년1월～2009년12월21례4～12세외이도담지류환자적림상화영상학특정급술중소견。수술방법：10례병변국한병능배합적인동채용문진청제병변；11례전마하수술。결과21례균이환이동통、류농혹유혈성삼액취진。검사발현외이도류농혹혈성삼액17례；유황백색발량혹회백색단괴상물12례；외이도종창8례；유육아5례；CT검사21례균견외이도연조직양영,12예외이도내단확대；외이도골질정거치상파배7례；고실순판파배4례；고막내이8례；침입상고실3례，유돌강1례。술중견13예외이도골부피부불동정도결손；10례고막후상부상피수손；2례고막긴장부천공；3례고막송이부천공。21례균수방6개월-2년미견복발。결론외이도담지류상침범외이도피부、고막、골질급중이，심지발생기타엄중병발증，조기증상은닉，다재이통혹감염시발현，응조기발현병급시철저청제병변，이감소병발증발생。
Objective To investigate the clinical characteristics of external auditory canal cholesteatoma in children and its early diagnosis. Methods Clinical and imaging features of external auditory canal cholesteatoma in 21 children treated in our hospital from 2007 Jan to 2009 Dec were analyzed. Treatment methods:In 10 cases in which the lesion was localized and the patient was able to cooperate, the lesion was removed on an outpatient basis in the office. The lesion was removed un-der general anesthesia in the rest 11 cases via surgical operation. Results Ear pain, itching or bloody drainage were the com-mon complaints in all 21 cases. Examination revealed purulent or hemorrhagic discharge in the external auditory meatus in 17 cases;a shiny white or yellow-white mass in 12 cases;external auditory canal swelling in 8 cases and granulation in 5 cases. CT scan showed soft tissue opacity in the external auditory canal in 21 cases, deep ear canal enlargement in 12 cases;external auditory canal irregular erosion in 7 cases;tympanic scute destruction in 4 cases;tympanic membrane shift in 8 cases;involve-ment of the epitympanum in 3 cases and of the mastoid in 1 case. Intra-operatively, skin damage in the deep ear canal was seen in 13 cases;epithelial damage over the superoposterior tympanic membrane in 10 cases;pars tensa perforation in 2 cases;and pars flaccida perforation in 3 cases. No recurrence was found during the 6 months to 2 years follow up in the 21 cases. Conclusions External ear canal cholesteatoma can cause extensive damage to surrounding structures with occult early symp-toms in children, often presenting with pain or infection. Early detection and prompt treatment of the lesion is important in avoiding serious complications.