Grachev N S, Polev G A, Morozov I I, Samarin A E, Vorozhtsov I N, Shcherbakov D A
Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Health of Russia, Moscow, Russia, 117997; Institute of Medical and Social Technologies, Department of Otorhinolaryngology, Moscow State University of Food Production, Moscow, Russia, 125080.
Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Health of Russia, Moscow, Russia, 117997.
Vestn Otorinolaringol. 2020;85(1):88-93. doi: 10.17116/otorino20208501188.
For the last decades endoscopic ear surgery has become a common practice. Advantages of the endoscopic technique in middle ear surgery are high definition and magnification of the endoscope with a modern camera and the ability to 'look around the corner' with the angled scope.
From March 2017 to November 2019 in NSRC PHOI named after Dmitry Rogachev in the Department of Oncology and Pediatric Surgery 53 patients (81 surgeries) have undergone endoscopic-assisted ear surgery: 3 biopsies for middle ear neoplasm with the transcanal endoscopic approach, 1 endoscopic tympanoplasty for attic retraction pocket with cholesteatoma, 2 endoscopic removal of middle ear tumors (including 1 combined approach) and 32 endoscopic myringoplasties, 22 canal wall down mastoidectomies for extensive middle ear and mastoid cholesteatoma, 21 second-look surgery with ossiculoplasty with overall good outcome. Age of the patients varied from 2 months to 16 years. Follow up period varied from 1 month to 3 years.
Two cases of middle ear tumor removal via endoscopic transcanal approach are described. In one case endoscopic transmeatal approach was used as an addition to the middle fossa approach for removal of facial nerve neurinoma located on the upper surface of petrous bone with expansion to the middle ear cavity. In the second case endoscopic transmeatal approach was used alone for removal of benign tumor (salivary gland choristoma) of middle ear cavity with extension to pneumatic system of petrous bone. In both cases endoscopic approach allowed to biopsy the tumor first and then to remove the tumor in a less invasive way, which lead to faster patient recovery.
In the majority of cases endoscopic technique is a method of assistance in otologic surgery, but sometimes could be a used a single method in middle ear surgery, allowing less traumatic approach and the implementation of high-definition camera for more precise disease control. In our preliminary experience endoscopic technique could be used in pediatric practice independently of the patient's age.
在过去几十年中，耳内镜手术已成为一种常见的手术方式。耳内镜技术在中耳手术中的优势在于，配备现代摄像头的内镜具有高清晰度和放大功能，以及使用角度内镜能够“环顾角落”的能力。
2017年3月至2019年11月，在以德米特里·罗加乔夫命名的国立儿童肿瘤研究所肿瘤与小儿外科，53例患者（共81次手术）接受了耳内镜辅助耳手术：采用经耳道内镜入路对3例中耳肿瘤进行活检，1例对伴有胆脂瘤的上鼓室陷凹进行内镜鼓膜成形术，2例内镜下切除中耳肿瘤（包括1例联合入路），32例内镜鼓膜修补术，22例对广泛的中耳和乳突胆脂瘤行开放式乳突根治术，21例二期探查手术并进行听骨链成形术，总体效果良好。患者年龄从2个月至16岁不等。随访期从1个月至3年不等。
描述了2例经内镜经耳道入路切除中耳肿瘤的病例。1例中内镜经耳道入路作为中颅窝入路的补充，用于切除位于岩骨上表面并向中耳腔扩展的面神经神经鞘瘤。另1例单独使用内镜经耳道入路切除中耳腔良性肿瘤（涎腺迷离瘤），该肿瘤已扩展至岩骨气房系统。在这2例中，内镜入路均允许先对肿瘤进行活检，然后以创伤较小的方式切除肿瘤，这使得患者恢复更快。
在大多数情况下，内镜技术是耳科手术中的一种辅助方法，但有时也可作为中耳手术的单一方法，采用创伤较小的入路，并使用高清摄像头以更精确地控制病情。根据我们的初步经验，内镜技术可独立应用于儿科患者，而不受患者年龄的限制。
