Bessa Renan Gonçalves, Tsuji Robinson Koji
Department of Otorhinolaryngology, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil.
Int Arch Otorhinolaryngol. 2023 Apr 28;27(2):e370-e376. doi: 10.1055/s-0043-1768202. eCollection 2023 Apr.
Recently, there have been significant advancements in transcanal endoscopic ear surgery (TEES). The combination of rigid and thin otoendoscopes with high-definition cameras enabled a less invasive transcanal access to the middle ear and a clearer view of the surgical field. Several surgeons have recently published studies about cholesteatoma resection via transcanal endoscopic surgery, even in cases where the disease has extended to the mastoid, requiring transcanal endoscopic mastoidectomy. To analyze the currently available literature on transcanal endoscopic inside-out mastoidectomy, and to determine its efficacy as a surgical technique by evaluating the disease's relapse/recurrence rate. Initially, the titles and abstracts of articles identified were analyzed. At this stage, 117 articles were analyzed, 97 of which were excluded for not meeting the inclusion criteria. The 20 remaining articles were further evaluated. The articles were classified on the basis of five levels of scientific evidence. The analysis of the studies showed that the transcanal endoscopic approach is effective in providing access to the attic or antrum, especially in cases of sclerotic mastoids. There was only one study with grade A recommendation, which showed the efficacy of endoscopic ear surgery in the treatment of cholesteatoma. Furthermore, there were three studies with grade B recommendation, showing less relapse/recurrence after TEES. More studies with grade A and B recommendations are needed to better evaluate the effectiveness of TEES, especially compared with that of traditional microscopic surgery.
最近，经耳道内镜耳手术（TEES）取得了重大进展。刚性和超薄耳内镜与高清摄像头的结合，使得经耳道进入中耳的侵入性更小，手术视野更清晰。最近，几位外科医生发表了关于经耳道内镜手术切除胆脂瘤的研究，甚至在疾病已蔓延至乳突、需要进行经耳道内镜乳突切除术的病例中也是如此。
分析目前关于经耳道内镜由内向外乳突切除术的文献，并通过评估疾病的复发率来确定其作为一种手术技术的疗效。
最初，对检索到的文章标题和摘要进行分析。在此阶段，共分析了117篇文章，其中97篇因不符合纳入标准而被排除。对剩下的20篇文章进行进一步评估。这些文章根据五级科学证据进行分类。
研究分析表明，经耳道内镜入路在进入上鼓室或鼓窦方面是有效的，尤其是在硬化性乳突的病例中。只有一项研究获得A级推荐，表明内镜耳手术治疗胆脂瘤的疗效。此外，有三项研究获得B级推荐，表明经耳道内镜耳手术后复发/再发较少。需要更多具有A级和B级推荐的研究，以更好地评估经耳道内镜耳手术的有效性，特别是与传统显微镜手术相比。
