CAJ | 학술논문

目的：探讨岩尖囊性病变的诊断及治疗，为诊治该类病变提供经验。方法回顾分析13例岩尖囊性病变的临床资料，包括胆脂瘤8例，胆固醇肉芽肿5例。全部行CT及MRI检查。13例手术治疗：其中经耳囊入路6例，耳蜗入路1例，颅中窝联合乳突入路1例，外耳道耳蜗下入路1例，迷路下入路1例，鼻内镜下经蝶窦斜坡入路3例。结果CT：病灶形态不规则6例，呈类圆形7例。MRI：T1WI低等信号、T2WI高信号8例，T1WI、T2WI均为高信号5例。术后随访1～2年，1例胆固醇肉芽肿术后复发，其余无复发。结论CT及MRI是早期诊断此类病变的重要手段。多种入路可有效切除或引流岩尖囊性病变。胆脂瘤结构破坏较重、病变范围较广，以充分暴露病变、彻底清除病灶为首要原则；胆固醇肉芽肿以引流通畅为首要原则。同时应根据病例特点优化径路，以最大限度保存正常结构及功能，胆固醇肉芽肿尽量行微创手术。
목적：탐토암첨낭성병변적진단급치료，위진치해류병변제공경험。방법회고분석13례암첨낭성병변적림상자료，포괄담지류8례，담고순육아종5례。전부행CT급MRI검사。13례수술치료：기중경이낭입로6례，이와입로1례，로중와연합유돌입로1례，외이도이와하입로1례，미로하입로1례，비내경하경접두사파입로3례。결과CT：병조형태불규칙6례，정류원형7례。MRI：T1WI저등신호、T2WI고신호8례，T1WI、T2WI균위고신호5례。술후수방1～2년，1례담고순육아종술후복발，기여무복발。결론CT급MRI시조기진단차류병변적중요수단。다충입로가유효절제혹인류암첨낭성병변。담지류결구파배교중、병변범위교엄，이충분폭로병변、철저청제병조위수요원칙；담고순육아종이인류통창위수요원칙。동시응근거병례특점우화경로，이최대한도보존정상결구급공능，담고순육아종진량행미창수술。
Objective To report authors’experiences in the diagnosis and treatment of cystic lesions in the petrous apex area. Methods Clinical data from 13 patients with petrous apex cystic lesions were retrospectively analyzed. The lesions in-cluded cholesteatoma (n = 8) and cholesterol granuloma (n = 5). All the patients received CT and MRI scan examinations and surgical treatment. Surgical approaches included transotic (n=6), transcochlear (n=1), combined middle fossa and mas-toid (n = 1), transmeatal retrocochlear (n = 1), infralabyrinthine (n = 1), and endoscopic transsphenoidal (n=3) techniques. Results The lesion was either irregular (n=6) or round shaped (n=7) on CT imaging. On MRI, lesion signal was low on T1WI and high on T2WI in 8 cases, and high on both T1WI and T2WI in 5 cases. Patients were followed up for 1~2 years. There was 1 recurrence of petrous apex cholesterol granuloma. Conclusion CT and MRI are important means for early diagnosis of these diseases. A variety of approaches can be used for resection or drainage of petrous apex cystic lesions. Adequate exposure and complete removal of the lesion is critical for cholesteatoma with extensive structural damage, while effective drainage is the most important for cholesterol granuloma. At the same time, the surgical approach should be individually designed for each particular patient, in order to maximize preservation of normal structures and function. In cholesterol granuloma, minimally in-vasive treatments should be considered.