Schmid H, Dort J C, Fisch U
Department of Otolaryngology, University Hospital Zurich, Switzerland.
Am J Otol. 1991 Mar;12(2):83-7.
Fifty-seven of 98 children with cholesteatoma treated between 1976 and 1985 were available for long-term follow-up. The clinical records of the 57 children were analyzed retrospectively. The purpose of this study was to compare the incidence of recurrent and/or residual cholesteatoma, postoperative otorrhea, and hearing results between two groups of patients. One group (n = 40) of children was treated with a radical mastoidoepitympanectomy (RMET) and the other group (n = 17) was treated with intact canal wall tympanoplasty/mastoidectomy (ICWT). Residual cholesteatomas were twice as frequent (17% versus 7.5%) in the ICWT group while recurrent disease was the same. There was no difference in postoperative otorrhea between the two patient groups. Hearing results were equally good in the Type III and in the ICWT group with staged TORP. It is concluded that a Type III tympanoplasty is an excellent one-stage method of hearing reconstruction in patients with good eustachian tube function and an intact stapes and that a correctly performed RMET offers a safe trouble free alternative to ICWT. In selected patients with limited disease and a well pneumatized mastoid, ICWT is still used.
1976年至1985年间接受治疗的98例胆脂瘤患儿中有57例可供长期随访。对这57例患儿的临床记录进行了回顾性分析。本研究的目的是比较两组患者复发性和/或残留性胆脂瘤的发生率、术后耳漏及听力结果。一组（n = 40）患儿接受了根治性乳突上鼓室切除术（RMET），另一组（n = 17）患儿接受了完整外耳道壁鼓室成形术/乳突切除术（ICWT）。ICWT组残留胆脂瘤的发生率是RMET组的两倍（17%对7.5%），而复发性疾病的发生率相同。两组患者术后耳漏情况无差异。在III型手术组和采用分期全听骨赝复物（TORP）的ICWT组中，听力结果同样良好。结论是，III型鼓室成形术是咽鼓管功能良好且镫骨完整患者进行听力重建的一种出色的一期手术方法，正确实施的RMET为ICWT提供了一种安全、无问题替代方案。在疾病范围有限且乳突气化良好的特定患者中，仍采用ICWT。
