Crowson Matthew G, Ramprasad Vaibhav H, Chapurin Nikita, Cunningham Calhoun D, Kaylie David M
Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
Laryngoscope. 2016 Nov;126(11):2574-2579. doi: 10.1002/lary.25941. Epub 2016 Mar 1.
OBJECTIVES/HYPOTHESIS: To analyze cost and compare cholesteatoma recidivism and hearing outcomes with single-stage and second-look operative strategies.
Retrospective review and cost analysis.
Adult and pediatric patients who underwent a tympanoplasty with mastoidectomy for cholesteatoma with a single-stage or second-look operative strategy were identified. Variables included procedure approach, residual or recurrent cholesteatoma, ossicular chain reconstruction frequency, and operative complications. Audiologic outcomes included pre-/postoperative air bone gap (ABG) and word recognition score (WRS). Cost analysis included charges for consultation and follow-up visits, surgical procedures, computed tomography temporal bone scans, and audiology visits.
One hundred and six patients had a tympanoplasty with mastoidectomy for cholesteatoma, with 80 canal wall-up procedures (CWU) as initial approach. Of these, 46 (57.5%) CWU patients had a planned second look. Two (4.3%) CWU patients had recurrent cholesteatoma and 20 (43.4%) had residual identified at second look. Four (11.7%) single-stage CWU strategy patients developed recurrent cholesteatoma. There was no significant difference in pre-/postoperative ABG and WRS between second look and single stage (P > 0.05). Compared to second-look patients, single-stage patients had significantly fewer postoperative visits (6.32 vs. 10.4; P = 0.007), and significantly lower overall charges for care ($23,529. vs. $41.411; P < 0.0001).
The goal of cholesteatoma surgery is to produce a safe ear, and a second-look strategy after CWU has historically been used to evaluate for recurrent or residual disease. The cholesteatoma recurrence rate at a second look after a CWU tympanoplasty-mastoidectomy is low. Costs of operative procedures are a significant proportion of healthcare resource expenditures. Considering the low rate of cholesteatoma recurrence and relatively high cost of care, implementation of a second-look strategy should be individually tailored and not universally performed.
目的/假设：分析成本，并比较采用一期手术和二期探查手术策略时胆脂瘤复发情况及听力结果。
回顾性研究与成本分析。
纳入接受胆脂瘤鼓室成形术伴乳突切除术的成年及儿科患者，手术策略为一期手术或二期探查。变量包括手术方式、残余或复发性胆脂瘤、听骨链重建频率及手术并发症。听力结果包括术前/术后气骨导差（ABG）及言语识别得分（WRS）。成本分析包括会诊及随访、外科手术、颞骨计算机断层扫描及听力检查的费用。
106例患者接受了胆脂瘤鼓室成形术伴乳突切除术，其中80例初始手术方式为开放式乳突根治术（CWU）。其中，46例（57.5%）CWU患者计划进行二期探查。2例（4.3%）CWU患者出现复发性胆脂瘤，20例（43.4%）在二期探查时发现有残余胆脂瘤。4例（11.7%）一期CWU手术策略患者出现复发性胆脂瘤。二期探查与一期手术患者的术前/术后ABG及WRS无显著差异（P>0.05）。与二期探查患者相比，一期手术患者术后就诊次数显著更少（6.32次对10.4次；P=0.007），总体护理费用显著更低（23,529美元对41,411美元；P<0.0001）。
胆脂瘤手术的目标是打造安全耳，历史上CWU术后的二期探查策略用于评估复发性或残余性疾病。CWU鼓室成形术-乳突切除术后二期探查时胆脂瘤复发率较低。手术费用在医疗资源支出中占很大比例。鉴于胆脂瘤复发率低且护理成本相对较高，二期探查策略的实施应个体化定制，而非普遍采用。
4。《喉镜》，126:2574 - 2579，2016年。
