Reimer A, Andreasson L, Harris S
ENT Department, General Hospital, Malmö, Sweden.
Clin Otolaryngol Allied Sci. 1987 Dec;12(6):447-54. doi: 10.1111/j.1365-2273.1987.tb00231.x.
In the Malmö community (230,000 inhabitants) 188 ears with cholesteatoma were operated on during 1975-1981. This number corresponds to an incidence of 12 cholesteatomas per 100,000 inhabitants a year. A detailed follow-up was possible in 164 ears. The primary operation was performed with an intact canal wall technique (CAT) in 148 ears and a radical operation in 40 ears. A planned second look was performed in 138 of the CAT ears and residual cholesteatoma was found in 41 or 30%, mainly in the epitympanic space. An initially good healing and hearing result was obtained in 71% but in the course of time several ears developed new retractions and a new mastoid cholesteatoma. The number of ears with perfect hearing tended to decrease with time, but about one-third of CAT ears remained intact with good hearing. The CAT technique is preferable in ears with a large mastoid air cell system and when the cholesteatoma is easily accessible by the approach. A planned second look should be performed including ossiculoplasty and obliteration of the antrum. In the remaining cases a radical operation including middle ear reconstruction and obliteration of the mastoid cavity is preferred.
在马尔默社区（23万居民），1975年至1981年间对188例胆脂瘤患者的耳朵进行了手术。这一数字相当于每年每10万居民中有12例胆脂瘤的发病率。对164只耳朵进行了详细的随访。148只耳朵采用完整外耳道壁技术（CAT）进行一期手术，40只耳朵进行根治性手术。对138只采用CAT技术的耳朵进行了计划性的二次探查，发现41只耳朵（占30%）有残留胆脂瘤，主要位于上鼓室。71%的耳朵最初获得了良好的愈合和听力结果，但随着时间的推移，几只耳朵出现了新的内陷和新的乳突胆脂瘤。听力完美的耳朵数量往往随着时间的推移而减少，但约三分之一采用CAT技术的耳朵听力仍保持良好且结构完整。当乳突气房系统较大且通过该入路易于接近胆脂瘤时，CAT技术更为可取。应进行计划性二次探查，包括听骨链成形术和鼓窦封闭术。在其余病例中，首选包括中耳重建和乳突腔封闭的根治性手术。
