Sanna M, Zini C, Scandellari R, Jemmi G
Am J Otol. 1984 Apr;5(4):277-82.
There are actually two principal approaches to the surgical treatment of middle ear cholesteatoma, a subject very much debated. First, the cholesteatoma can be exteriorized and treated with an open technique (classic or modified radical mastoidectomy, open tympanoplasty); and second, the radical removal of the cholesteatoma is also possible in the majority of cases by closed tympanoplasty. In this article we examine 283 patients (forty-four children and 239 adults) operated on by the closed technique to review and discuss the postsurgical cholesteatoma problem (residual and recurrent). Total incidence of residual cholesteatoma is 13.43 percent. It is higher in children (25 percent) than in adults (11.72 percent) and is more frequently localized in the mesotympanum (47.54 percent) than in the epitympanum (40.98 percent) or in the mastoid (6.56 percent). Recurrent cholesteatoma, with a total incidence of 7.77 percent, is much less frequent when staged tympanoplasty has been performed than when a one-stage operation has been done. No endotemporal or endocranial complications (labyrinthine fistula, facial nerve paralysis) have been noticed in cases of postsurgical cholesteatoma. These data confirm the opinion that staged tympanoplasty with Silastic sheeting and reconstruction of the erosions of the posterior wall is the technique of choice for surgical therapy of middle ear cholesteatoma.
中耳胆脂瘤的外科治疗实际上有两种主要方法，这是一个备受争议的话题。第一，胆脂瘤可通过开放技术（经典或改良根治性乳突切除术、开放式鼓室成形术）进行外置处理；第二，在大多数情况下，通过闭合式鼓室成形术也可以彻底切除胆脂瘤。在本文中，我们研究了283例采用闭合技术手术的患者（44名儿童和239名成人），以回顾和讨论术后胆脂瘤问题（残留和复发）。残留胆脂瘤的总发生率为13.43%。儿童中的发生率（25%）高于成人（11.72%），且更常见于中鼓室（47.54%），而非上鼓室（40.98%）或乳突（6.56%）。复发性胆脂瘤的总发生率为7.77%，分期鼓室成形术的发生率远低于一期手术。术后胆脂瘤病例未发现颞内或颅内并发症（迷路瘘、面神经麻痹）。这些数据证实了以下观点，即使用硅橡胶片进行分期鼓室成形术并重建后壁侵蚀是中耳胆脂瘤外科治疗的首选技术。
