摘要
目的探讨螺旋CT在显示中耳结构时的优越性及临床价值。方法分析97例中耳炎患者术前螺旋CT特征,将手术结果与CT表现进行对比分析。结果螺旋CT能清楚地显示起源部位不同和大小不等的中耳软组织影填塞征象及其引起的中耳系统细微的骨质破坏征象。早期中耳炎16例,CT与手术结果符合率为100%;慢性中耳炎软组织在中耳系统填充部位的CT征象与手术结果的平均符合率为93.3%,各部位的骨质破坏情况与手术结果的平均符合率为89.8%,听骨链破坏的CT征象与手术结果符合率为83.5%。中耳炎后遗症CT征象与手术结果符合率为97.2%。螺旋CT表现:早期中耳炎为黏膜增厚,病灶分布较弥散,有时可见液平;慢性中耳炎为:1)中耳腔内团块状影、周围有低密度环包绕;2)骨质改变,包括中耳腔扩大、周缘骨质硬化,听小骨移位、破坏,严重者可伴有乙状窦壁、鼓室盖、面神经管及半规管的破坏;3)大多数为硬化型乳突。中耳炎后遗症为鼓室钙化影,密度不均匀。结论中耳炎藉螺旋CT征象不仅可做出准确分型,而且是中耳炎诊断、鉴别诊断的可靠依据,对判定骨质破坏的范围和软组织充填的部位,制定手术方案和评估治疗效果,具有重要的指导意义。螺旋CT应作为中耳乳突手术前常规检查项目。
Objective To discuss clinical value of spiral CT scanning in showing anatomical structure in chronic otitis media.Method The clinical data and preoperative spiral CT manifestation of 97 cases of chronic otitis media(COM) ere retrospectively comparative analyzed .All cases were diagnosed by operation and pathology.Results Spiral CT can accurately show the occupancy image of different sites and sizes of soft-tissue and the minor bony-erosion image in middle ear. Match rate between CT manifestation and operation was 100% in 16 cases of early COM; 93.3% between CT manifestation of soft-tissue in middle ear and operation; 89.8% between that of bony-erosion and operation; 83.5% between that of osicular cain destruction and operation. 97.2% between that of sequelae of COM and operation. Spiral CT scanning manifestation of early COM was mucosal thickening, distribution of lesions and diffusion, sometimes liquid; That of COM was: 1 mission massive shadow wrapping by low-density central;2 Bone changes,including enlargement of tympanic cavity with sclerotic border, the dislocation and destruction of the ossicles.The sigmoid sinus plate, tympanic tegmen, semicircular canal and facial nerve canal were destroyed in severe cases;3 Sclerotic mastoid was observed in most cases. That of sequelae of COM was calcification shadow with uneven density.Conclusion Spiral CT imaging not only provide with accurate typing and reliable basis for diagnosis and different diagnosis of COM, but also plays an important role in judging scope of bone destruction and sites of soft-tissue filling, making operation programme and evaluting surgical treatment effect. Spiral CT scanning should be as routine examination prior to middle ear and mastoid surgery.
引文
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