Cohen Michael S, Basonbul Razan A, Kozin Elliott D, Lee Daniel J
1 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.
Otolaryngol Head Neck Surg. 2017 Dec;157(6):1034-1040. doi: 10.1177/0194599817729136. Epub 2017 Sep 5.
Objectives To determine the rate of residual cholesteatoma during planned second-look procedures in pediatric patients following primary cholesteatoma resection using endoscopic and microscopic operative approaches. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Outcomes from pediatric patients undergoing cholesteatoma surgery from January 2011 through August 2015 were analyzed. Cholesteatoma extent at initial resection was staged, and comparison among endoscopic dissection and microscopic or endoscopic inspection groups was made. Presence of disease at time of planned second look was quantified. Descriptive analysis was performed. Results Fifty-five patients (56 ears) with planned second-look procedures were included and underwent a total of 120 procedures. Median age was 11 years (6.7-13 years). Endoscopes were used for inspection in 25 (39%) primary resections and for dissection in 39 (61%) primary resections. Extent of disease at the time of primary resection was similar among groups (χ, P = .72). Cases where the endoscope was used for inspection only or not at all during primary resection had a 24% rate of residual cholesteatoma at the time of second look compared with a 23% rate for cases with endoscopic dissection (χ, P = .93). Rate of mastoidectomy significantly decreased from 63% to 33% over the study period ( P = .04) with similar disease extent ( P = .99). Conclusions Residual cholesteatoma rates during planned second-look procedures were similar between the study groups. Use of the endoscope led to a lower rate of mastoidectomy for cases with similar disease extent.
目的 确定在小儿原发性胆脂瘤切除术后采用内镜和显微镜手术入路进行计划性二次探查手术时残余胆脂瘤的发生率。研究设计 病例系列研究并进行图表回顾。研究地点 三级医疗中心。研究对象和方法 分析2011年1月至2015年8月接受胆脂瘤手术的小儿患者的结局。对初次切除时胆脂瘤的范围进行分期，并比较内镜下切除组与显微镜或内镜检查组。对计划性二次探查时疾病的存在情况进行量化。进行描述性分析。结果 纳入55例（56耳）进行计划性二次探查手术的患者，共进行了120次手术。中位年龄为11岁（6.7 - 13岁）。25例（39%）初次切除使用内镜进行检查，39例（61%）初次切除使用内镜进行切除。各组初次切除时疾病范围相似（χ，P = 0.72）。初次切除时仅使用内镜检查或根本未使用内镜检查的病例，二次探查时残余胆脂瘤发生率为24%，而内镜下切除的病例为23%（χ，P = 0.93）。在研究期间，乳突切除术的发生率从63%显著降至33%（P = 0.04），而疾病范围相似（P = 0.99）。结论 研究组在计划性二次探查手术时残余胆脂瘤发生率相似。在疾病范围相似的病例中，使用内镜导致乳突切除术的发生率较低。
