Roger G, Schlegel N, Chauvin P, Denoyelle F, Garabedian E N
Service d'ORL Pédiatrique et de Chirurgie Cervico-Faciale, Hôpital d'Enfants Armand Trousseau, Paris.
Ann Otolaryngol Chir Cervicofac. 1995;112(6):262-74.
The decision on the appropriate surgical technique for treating cholesteatoma in children raises a number of controversial questions, most because of personal convictions rather than because of established data. We attempted to determine which patients are at risk of residual cholesteatoma in order to propose the most rational therapeutic strategy. A retrospective study of 250 children with cholesteatoma or severe retraction underwent surgery between 1986 and 1992. During this period 69 cases of residual cholesteatoma were recorded during a second intervention. After a mean follow-up of 33 months after the final operation, the Kaplan-Meier plot shows a rate of 31% and 34% at 3 and 5 years respectively. The univariate and multivariate (Cox regression) analysis was performed to search for a correlation between residual cholesteatoma development and past history including type of process involved, peroperative findings and surgical technique. Three factors were closely and independently related (p < 0.003) to residual cholesteatoma: invasion of the posterior middle ear, presence of ossicular erosion after excision and presumption of incomplete ablation. Inversely, age, surgical history, extension and nature of the process involved as well as surgical technique had no effect on development of residual cholesteatoma. Only one comparable study has been published where only ossicular erosion was found to be significant on multivariate analysis. The presence of one or more of the three of the factors mentioned above should lead to a second intervention, perhaps after a short delay, whatever the initial technique (open or closed).
对于治疗儿童胆脂瘤选择何种合适的手术技术这一问题引发了诸多争议，多数争议源于个人观点而非确凿的数据。我们试图确定哪些患者存在残余胆脂瘤的风险，以便提出最合理的治疗策略。对1986年至1992年间接受手术的250例患有胆脂瘤或严重中耳内陷的儿童进行了一项回顾性研究。在此期间，在二次干预时记录到69例残余胆脂瘤病例。在最后一次手术后平均随访33个月，Kaplan-Meier曲线显示3年和5年时的发生率分别为31%和34%。进行单因素和多因素（Cox回归）分析，以寻找残余胆脂瘤发生与既往病史之间的相关性，既往病史包括所涉及病变的类型、术中发现和手术技术。有三个因素与残余胆脂瘤密切且独立相关（p<0.003）：中耳后部受累、切除后听小骨侵蚀以及推测为不完全切除。相反，年龄、手术史、所涉及病变的范围和性质以及手术技术对残余胆脂瘤的发生没有影响。仅有一项可比研究发表，在该研究中多因素分析仅发现听小骨侵蚀具有显著性。无论初始技术（开放式或封闭式）如何，上述三个因素中存在一个或多个都应导致二次干预，或许可稍作延迟后进行。
