Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, 2-2-2 Iida-nishi, Yamagata-shi, Yamagata 990-9585, Japan.
Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, 2-2-2 Iida-nishi, Yamagata-shi, Yamagata 990-9585, Japan.
Auris Nasus Larynx. 2024 Oct;51(5):898-904. doi: 10.1016/j.anl.2024.08.004. Epub 2024 Aug 31.
To determine the predictive factors for residual disease occurring after surgical removal of congenital cholesteatomas and whether these predictive factors differ between microscopic ear surgery (MES) using data from the literature and transcanal endoscopic ear surgery (TEES) using data from our own institution.
Twenty-three patients with a congenital cholesteatoma who underwent surgical treatment at Yamagata University Hospital between December 2011 and December 2017 were retrospectively investigated. We divide TEES into three different approaches: non-powered TEES, powered TEES and dual MES/TEES. Main outcome measures were Potsic stage, closed or open congenital cholesteatoma type, TEES surgical approach, appearance of residual disease, tympanoplasty type and hearing outcome.
A logistic regression analysis was conducted on the Potsic stage, closed or open type, TEES surgical approach and age to obtain the odds ratio for residual disease. The chance of residual disease significantly increased in the presence of an open-type congenital cholesteatoma (odds ratio: 30.82; 95 % confidence interval: 1.456-652.3; p = 0.0277), but not for any of the other factors including Potsic stage. The timing of the confirmation of residual disease after ossicular chain reconstruction was analyzed using a Kaplan-Meier analysis. The residual disease rate was significantly higher with an open-type congenital cholesteatoma (log-rank test, p < 0.05). In addition, all residual disease occurred within three years after surgery.
Our results showed that an open-type congenital cholesteatoma is the strongest predictive factor for residual disease when removing a congenital cholesteatoma by TEES.
确定先天性胆脂瘤切除术后残留病变的预测因素，并比较使用文献中显微镜下耳部手术（MES）数据和使用我们机构数据的经耳道内镜耳部手术（TEES）数据的预测因素是否存在差异。
回顾性分析 2011 年 12 月至 2017 年 12 月在山形大学医院接受手术治疗的 23 例先天性胆脂瘤患者。我们将 TEES 分为三种不同的方法：非动力 TEES、动力 TEES 和双 MES/TEES。主要观察指标为波蒂斯分期、闭合型或开放型先天性胆脂瘤类型、TEES 手术方法、残留病变的表现、鼓室成形术类型和听力结果。
对波蒂斯分期、闭合型或开放型、TEES 手术方法和年龄进行逻辑回归分析，以获得残留病变的优势比。开放型先天性胆脂瘤的残留病变风险显著增加（优势比：30.82；95%置信区间：1.456-652.3；p=0.0277），但其他因素（包括波蒂斯分期）均无此风险。采用 Kaplan-Meier 分析对听骨链重建后残留病变的确诊时间进行分析。开放型先天性胆脂瘤的残留病变发生率显著较高（对数秩检验，p<0.05）。此外，所有残留病变均发生在术后 3 年内。
我们的结果表明，TEES 切除先天性胆脂瘤时，开放型先天性胆脂瘤是残留病变的最强预测因素。
