Glikson Eran, Yousovich Ruth, Mansour Jobran, Wolf Michael, Migirov Lela, Shapira Yisgav
*Department of Otolaryngology, Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer †Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Otol Neurotol. 2017 Jun;38(5):e41-e45. doi: 10.1097/MAO.0000000000001395.
To evaluate the clinical parameters, outcomes, and complications of transcanal endoscopic ear surgeries for middle ear cholesteatoma.
Retrospective study.
Tertiary university-affiliated medical center.
Adult patients (age >18) who underwent transcanal endoscopic ear surgeries for cholesteatoma, between March 2009 and March 2015.
Transcanal endoscopic surgery was indicated when the cholesteatoma did not extend posterior to the anterior limb of the lateral semicircular canal. Rigid endoscopes 4 and 2.7 mm in diameter, 0, 30, 45, and 70 degrees were used with angled picks, suction, and forceps.Preoperative assessment included high-resolution computed tomography of the temporal bones and/or non echo-planar diffusion-weighted magnetic resonance imaging and pure-tone audiometry.
Residual or recurrent disease was diagnosed by clinical examination and/or magnetic resonance imaging findings consistent with cholesteatoma. Intra- and postoperative complications, pre- and postoperative audiometric results were recorded.
Sixty operations (56 patients, mean age = 43.6) were included.Six operations (10%) were performed under local anesthesia. The most common sites of cholesteatoma involvement were: posterior epitympanum (n = 51, 91%), anterior epitympanum (n = 19, 33.9%), posterior mesotympanum (n = 13, 23.2%), and sinus tympani (n = 11, 19.6%). Intraoperative ossicular chain reconstruction was performed in 18 (30%) cases.Our overall residual and recurrence rates were 10% (n = 6) and 8.3% (n = 5), respectively, with mean duration of follow up of 35 months. The most common sites of residual disease were the mastoid cavity/antrum (n = 3, 50%), tympanic cavity, and posterior mesotympanum. Overall minor and major complication rates were 16.6 and 6%, respectively.
Transcanal endoscopic ear surgery was found to be an acceptable and safe technique for the exposure and eradication of middle ear and/or attic cholesteatoma.
评估经耳道内镜中耳胆脂瘤手术的临床参数、疗效及并发症。
回顾性研究。
大学附属三级医疗中心。
2009年3月至2015年3月期间接受经耳道内镜中耳胆脂瘤手术的成年患者（年龄>18岁）。
当胆脂瘤未延伸至外侧半规管前支后方时，采用经耳道内镜手术。使用直径4mm和2.7mm的硬性内镜，0°、30°、45°和70°视角，并配备角形刮匙、吸引器和镊子。术前评估包括颞骨高分辨率计算机断层扫描和/或非回波平面扩散加权磁共振成像以及纯音听力测定。
通过临床检查和/或与胆脂瘤一致的磁共振成像结果诊断残留或复发性疾病。记录术中及术后并发症、术前及术后听力测定结果。
纳入60例手术（56例患者，平均年龄=43.6岁）。6例手术（10%）在局部麻醉下进行。胆脂瘤最常见的累及部位为：上鼓室后部（n=51，91%）、上鼓室前部（n=19，33.9%）、中鼓室后部（n=13，23.2%）和鼓室窦（n=11，19.6%）。18例（30%）患者术中进行了听骨链重建。我们的总体残留率和复发率分别为10%（n=6）和8.3%（n=5），平均随访时间为35个月。残留疾病最常见的部位是乳突腔/鼓窦（n=3，50%）、鼓室和中鼓室后部。总体轻微和严重并发症发生率分别为16.6%和6%。
经耳道内镜中耳手术被认为是一种可接受且安全的技术，用于暴露和根除中耳和/或上鼓室胆脂瘤。
