Neudert Marcus, Lailach Susen, Lasurashvili Nikoloz, Kemper Max, Beleites Thomas, Zahnert Thomas
Department of Otorhinolaryngology, Head and Neck Surgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Saxony, Germany.
Otol Neurotol. 2014 Dec;35(10):1801-8. doi: 10.1097/MAO.0000000000000484.
To compare cholesteatoma recidivism rates after exclusive transcanal technique (ETC), combined transcanal and mastoidal technique (TCM, both subsets of intact canal wall technique, ICW), and canal wall down surgery (CWD).
Retrospective case review and clinical case study
Tertiary referral center.
406 cholesteatoma surgeries (2007-2009), 116 ears in clinical re-examination at least 1 year postoperatively.
Sequential cholesteatoma surgery with ETC, TCM, or CWD.
Cholesteatoma recidivism, residual and recurrent disease, localization of recidivism, validity of clinical findings.
Out of 406 patients, ETC was performed in 227 (56%), TCM in 122 (30%), and CWD in 57 (14%) cases. Recidivism rates after ICW (15%) and CWD (16%) were almost similar. Recidivism was more frequent after ETC (11%) than after TCM (25%). Residuals were observed in 2% after ETC, 6.5% after TCM, and 7% after CWD. Incidence of recurrent disease was 9% for ETC, 18% for TCM, and 9% for CWD. Preferred localization of recidivism was the tympanic cavity after ETC (92%) and CWD (56%) and the mastoid cavity after TCM (53%). The clinical re-examination showed no further recidivistic disease.
Sequential surgery is an effective and successful strategy in cholesteatoma eradication, providing a similar recidivism rate compared to following cholesteatoma retrograde and resection of the posterior canal wall. Lower recidivism after ETC was observed as a consequence of limited disease and the postoperative middle ear status determined the higher rate of recurrence after TCM. Therefore, the restricted visualization of the middle ear during ICW surgery does not increase the rate of recidivism, compared with CWD, as described in other studies. Cholesteatoma recidivism is mainly attributed to the surgeon's experience that outweighs the chosen strategy.
比较单纯经耳道技术（ETC）、经耳道联合乳突技术（TCM，均为完整外耳道壁技术，ICW的子集）和外耳道壁下手术（CWD）后胆脂瘤复发率。
回顾性病例分析和临床病例研究
三级转诊中心。
406例胆脂瘤手术（2007 - 2009年），116耳术后至少1年接受临床复查。
采用ETC、TCM或CWD进行序贯性胆脂瘤手术。
胆脂瘤复发、残留及复发性疾病、复发部位、临床检查结果的有效性。
406例患者中，227例（56%）采用ETC手术，122例（30%）采用TCM手术，57例（14%）采用CWD手术。ICW（15%）和CWD（16%）后的复发率几乎相似。ETC（11%）后的复发比TCM（25%）更频繁。ETC后2%观察到残留，TCM后6.5%，CWD后7%。复发性疾病的发生率ETC为9%，TCM为18%，CWD为9%。ETC（92%）和CWD（56%）后复发的首选部位是鼓室，TCM后（53%）是乳突腔。临床复查未发现进一步的复发性疾病。
序贯手术是根除胆脂瘤的一种有效且成功的策略，与胆脂瘤逆行切除及后外耳道壁切除术相比，复发率相似。ETC后复发率较低是由于病变范围有限，而术后中耳状况决定了TCM后较高的复发率。因此，与其他研究中所述的CWD相比，ICW手术中中耳可视化受限并未增加复发率。胆脂瘤复发主要归因于外科医生的经验，其重要性超过了所选择的手术策略。
