Dornhoffer J L
Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock 72205, USA.
Ann Otol Rhinol Laryngol. 2000 Nov;109(11):1033-9. doi: 10.1177/000348940010901108.
The goal of this retrospective study was to report the preliminary results of the retrograde mastoidectomy technique with canal wall reconstruction used as a primary treatment method for cholesteatoma. This synthesis of canal wall up (CWU) and canal wall down (CWD) techniques was performed in 70 patients (75 ears; 35 pediatric, 40 adult) with an average 45-month follow-up. Surgical intervention involved removal of a portion of the canal wall for exposure and extirpation of the cholesteatoma, followed by reestablishment of the canal wall during reconstruction in a single stage. This leaves the mucosa relatively undisturbed and limits the extent of canal wall removal, facilitating mastoid aeration and preservation of anatomy. Recurrent disease occurred in 5% of cases. The hearing improvement was statistically significant (p < .05), with an average preoperative 4-frequency pure tone average air-bone gap of 27.2 dB improving to 11.5 dB. No patient had a worsening of hearing. The surgery takes less time than traditional techniques, is reproducible and easily taught, and can be universally applied to all cholesteatoma patients as primary treatment.
这项回顾性研究的目的是报告采用外耳道后壁重建的逆行乳突切除术技术作为胆脂瘤主要治疗方法的初步结果。对70例患者（75耳；35例儿童，40例成人）实施了这种外耳道后壁上提（CWU）和外耳道后壁下翻（CWD）技术的综合术式，平均随访45个月。手术干预包括切除部分外耳道壁以暴露和清除胆脂瘤，然后在重建过程中一次性重建外耳道壁。这样可使黏膜相对不受干扰，并限制外耳道壁的切除范围，有利于乳突通气和解剖结构的保留。5%的病例出现疾病复发。听力改善具有统计学意义（p < 0.05），术前4频率纯音平均气骨导差平均为27.2 dB，改善至11.5 dB。没有患者听力恶化。该手术比传统技术耗时更少，可重复且易于传授，并且可以普遍应用于所有胆脂瘤患者作为主要治疗方法。
