Marchioni Daniele, Rubini Alessia, Gonzalez-Navarro Mauricio, Alicandri-Ciufelli Matteo, James Adrian, Presutti Livio
Department of Otolaryngology - Head & Neck Surgery, University of Verona, Piazzale Aristide Stefani, 1 37126 Verona, Italy.
Department of Otolaryngology - Head & Neck Surgery, University of Verona, Piazzale Aristide Stefani, 1 37126 Verona, Italy.
Int J Pediatr Otorhinolaryngol. 2017 Aug;99:146-151. doi: 10.1016/j.ijporl.2017.06.006. Epub 2017 Jun 15.
To describe a multicenter study regarding surgical management of bilateral congenital cholesteatoma (BCC) and underline the importance of endoscopes in the management of this condition. In BCC, hearing preservation is more crucial than in unilateral cases. The endoscopic approach allows complete removal of cholesteatoma via a minimally invasive technique offering low residual disease rates while preserving the normal physiology of the middle ear and possibly the ossicular chain.
Retrospective chart and surgical video review of patients with BCC who underwent surgery at Otolaryngology Department of Modena and Verona University Hospitals and the Hospital for Sick Children, Toronto.
From 2002 to November 2016, six patients were identified with bilateral congenital cholesteatoma and included in this study. Pre-operative assessments, surgical treatments and outcomes were collected and described.
The median age at presentation was 4 years (range 2-7 years). A microscopic post auricular tympanoplasty was performed in two ears, four underwent a canal wall up mastoidectomy procedure and in the other six a transcanal endoscopic approach (TEA) was used. No intra- or post-operative complications were observed in any patients. The mean follow up period was 54.5 months.
When both ears are involved with congenital cholesteatoma, it is particularly important to use a minimally invasive technique that preserves normal ossicular and mastoid structure and function whenever possible. In many cases this can be achieved with TEA, even in young children. In addition the endoscope allows good surgical control of cholesteatoma removal from hidden recesses.
描述一项关于双侧先天性胆脂瘤（BCC）手术治疗的多中心研究，并强调内镜在该疾病治疗中的重要性。在双侧先天性胆脂瘤中，听力保留比单侧病例更为关键。内镜手术方法能够通过微创技术完整切除胆脂瘤，残留病变率低，同时保留中耳及可能的听骨链的正常生理功能。
对在摩德纳和维罗纳大学医院耳鼻喉科以及多伦多病童医院接受手术的双侧先天性胆脂瘤患者进行回顾性病历及手术视频分析。
2002年至2016年11月期间，确定6例双侧先天性胆脂瘤患者纳入本研究。收集并描述术前评估、手术治疗及结果。
就诊时的中位年龄为4岁（范围2 - 7岁）。两只耳朵进行了显微镜下耳后鼓室成形术，四只耳朵接受了外耳道后壁上鼓室乳突根治术，另外六只耳朵采用了经耳道内镜手术（TEA）。所有患者均未观察到术中或术后并发症。平均随访期为54.5个月。
当双耳均患有先天性胆脂瘤时，尽可能使用保留正常听骨和乳突结构及功能的微创技术尤为重要。在许多情况下，即使是幼儿，经耳道内镜手术也能实现这一点。此外，内镜有助于很好地控制从隐蔽部位切除胆脂瘤的手术操作。
