Al Anazy Fatma Homood
King Abdulaziz University Hospital, P.O. Box 245, Riyadh 11411, Saudi Arabia.
Int J Pediatr Otorhinolaryngol. 2006 Oct;70(10):1683-6. doi: 10.1016/j.ijporl.2006.03.008. Epub 2006 Jul 5.
To report the occurrence of cholesteatoma following myringotomy and insertion of ventilating tube (VT) in a residency training program.
Nine hundred and eighty-four children who were operated for grommet insertion with or without adenotonsillectomy during the year 1999-2003 were included in the study. Children were divided into two groups: group 1 (648 children) operated by residents and group 2 (305 children) operated by consultant. All procedures were carried out under general anesthesia using Ziess operating microscope. Shah ventilating tubes were used in most cases and Goody T tube in some others.
Nine ears developed cholesteatoma, six with perforation and three with pearl cholesteatoma cyst and intact tympanic membrane. The rate of iatrogenic cholesteatoma occurrence was 0.62% when done by residents (group 1) and 0.33% when operated by consultants (group 2). The overall prevalence was 0.48%.
Iatrogenic cholesteatoma occuring as a complication following VT insertion is not uncommon. It occurs more often following surgery done by inexperienced surgeons. Excessive manipulation may cause meatal wall and drum surface epithelium injury. This epithelium might be pushed with the VT into the middle ear.
报告在住院医师培训项目中鼓膜切开置管术后胆脂瘤的发生情况。
纳入1999年至2003年间接受鼓膜置管术（无论是否同时行腺样体扁桃体切除术）的984例儿童。儿童分为两组：第1组（648例儿童）由住院医师手术，第2组（305例儿童）由顾问医师手术。所有手术均在全身麻醉下使用蔡司手术显微镜进行。大多数情况下使用沙阿通气管，其他一些情况使用古迪T型管。
9耳发生胆脂瘤，6耳有穿孔，3耳有珍珠样胆脂瘤囊肿且鼓膜完整。住院医师手术（第1组）时医源性胆脂瘤发生率为0.62%，顾问医师手术（第2组）时为0.33%。总体发生率为0.48%。
鼓膜置管术后作为并发症出现的医源性胆脂瘤并不罕见。在经验不足的外科医生手术后更常发生。过度操作可能导致外耳道壁和鼓膜表面上皮损伤。这种上皮可能会随通气管被推入中耳。
