Kerckhoffs Kelly G P, Kommer Maarten B J, van Strien Thom H L, Visscher Simeon J A, Bruijnzeel Hanneke, Smit Adriana L, Grolman Wilko
Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands.
Brain Center Rudolf Magnus, Utrecht, The Netherlands.
Laryngoscope. 2016 Apr;126(4):980-7. doi: 10.1002/lary.25591. Epub 2015 Sep 25.
OBJECTIVES/HYPOTHESIS: To review which type of cholesteatoma surgery, canal wall up (CWU) or canal wall down (CWD), provides the lowest risk for residual and/or recurrent disease in adults with primary acquired cholesteatoma.
PubMed, Embase, CINAHL, the Cochrane Library, Scopus and Web of Science.
We selected articles comparing CWU with CWD, reporting on disease recidivism (combined residual and recurrent disease) or independent residual or disease recurrence rates. We included studies with a moderate to high relevance.
Our search yielded 2,060 articles. We selected seven studies that carried a moderate risk of bias. Six studies described higher disease recidivism after the CWU procedure [16.7-61.0%] compared to the CWD technique [0-13.2%]. Four studies showed statistical significant difference (P < .05). One study showed opposite results: recidivism was found in 7.8% CWU and in 22.1% CWD cases (P < .001). Studies showed CWU recidivism more likely to be residual disease, whereas CWD recidivism tended to be recurrent disease.
The majority of included studies showed CWU to result in more disease recidivism compared to the CWD technique in adult patients with a primary acquired cholesteatoma. If recidivism risk is the most important factor to consider a certain surgical technique, we recommend application of the CWD procedure. However, many additional factors in patient care will define the best treatment decision, such as residual hearing and access to health care. Our recommendations are based on Level II evidence, which underlines the need for future high-level evidence studies.
目的/假设：回顾哪种类型的胆脂瘤手术，即上鼓室开放术（CWU）或下鼓室开放术（CWD），在原发性获得性胆脂瘤成年患者中导致残留和/或复发性疾病的风险最低。
PubMed、Embase、CINAHL、Cochrane图书馆、Scopus和Web of Science。
我们选择了比较CWU和CWD的文章，报告疾病复发（残留和复发性疾病合并）或独立的残留或疾病复发率。我们纳入了相关性为中度到高度的研究。
我们的检索产生了2060篇文章。我们选择了7项存在中度偏倚风险的研究。6项研究描述了与CWD技术[0 - 13.2%]相比，CWU手术后疾病复发率更高[16.7 - 61.0%]。4项研究显示有统计学显著差异（P < 0.05）。1项研究显示了相反的结果：CWU病例的复发率为7.8%，CWD病例为22.1%（P < 0.001）。研究表明，CWU复发更可能是残留疾病，而CWD复发倾向于复发性疾病。
大多数纳入研究表明，在原发性获得性胆脂瘤成年患者中，与CWD技术相比，CWU导致更多的疾病复发。如果复发风险是考虑某种手术技术的最重要因素，我们建议应用CWD手术。然而，患者护理中的许多其他因素将决定最佳治疗决策，如残余听力和获得医疗保健的机会。我们的建议基于二级证据，这突出了未来进行高级别证据研究的必要性。
