Darrouzet V, Duclos J Y, Portmann D, Portmann M, Bebear J P
Service d'ORL, Hôpital Pellegrin, Bordeaux.
Ann Otolaryngol Chir Cervicofac. 1997;114(7-8):272-83.
A retrospective study of 215 cases of cholesteatoma in 199 children operated on from 1985 to 1996 was conducted. Mean age of the children was 9.6 years. Bilateral cholesteatoma was present in 32 cases (8%). The cause was congenital in 32 cases (16%), iatrogenic in 24 cases (11%) and secondary or acquired in 63%. The surgical procedure was a closed technique in 88%, an open technique with or without ossiculoplasty in 10%, and exclusion of the ear using the Rambo technique in exceptional cases (1%). The facial nerve was exposed in 17%. A labyrinth fistula was discovered in 4%, and an intracranial suppuration in only 0.5%. A secondary open procedure was required in 5 cases (2.5%) and secondary exclusion 3 times (1.5%). The ossicular chain was interrupted in 24.2% of the cases and ossicular rehabilitation was performed in 68% of the cases (39% type II, 29% type III), including 49% during the first procedure. At least 2 operations were needed in 62% of the children and 21% had 3 operations. Residual cholesteatomas were observed in 21.5% of all children in the series, 33% in those with a second operation. Recurrence rate was 10%. Mean hearing loss was 28 dB for a mean gain of 4 dB. Post-operative hearing capacity was socially useful in 64% of the cases, including 12% who had normal hearing. Labyrinthization was observed in 15 cases, including 4 cases with total hearing loss. These result are in general agreement with data in the literature. Our strategy is based on a closed procedure for cholesteatomy and systematic re-evaluation at 1 year. The open technique is useful for very extensive lesion on a narrow mastoid, either as second intention procedure or more rarely as a first intention procedure. Management in children differs from that in adults since in adults the destruction has usually progressed further in a mastoid which accepts an open procedure more readily.
对1985年至1996年期间接受手术的199名儿童的215例胆脂瘤病例进行了回顾性研究。儿童的平均年龄为9.6岁。双侧胆脂瘤32例（8%）。病因先天性32例（16%），医源性24例（11%），继发性或后天性63%。手术方法88%为闭合技术，10%为有或无听骨成形术的开放技术，特殊情况下（1%）采用兰博技术切除耳部。17%暴露面神经。发现迷路瘘4%，颅内化脓仅0.5%。5例（2.5%）需要二次开放手术，3例（1.5%）需要二次切除。24.2%的病例听骨链中断，68%的病例进行了听骨重建（II型39%，III型29%），其中49%在首次手术时进行。62%的儿童至少需要2次手术，21%的儿童需要3次手术。该系列所有儿童中21.5%观察到残余胆脂瘤，二次手术者中33%有残余胆脂瘤。复发率为10%。平均听力损失为28dB，平均增益为4dB。64%的病例术后听力对社交有用，其中12%听力正常。观察到15例内耳形成，其中4例全聋。这些结果与文献数据基本一致。我们的策略基于胆脂瘤切除术的闭合手术方法和1年时的系统重新评估。开放技术适用于狭窄乳突上非常广泛的病变，可作为二期愈合手术，或更罕见地作为一期愈合手术。儿童的治疗与成人不同，因为成人的破坏通常在更易接受开放手术的乳突中进展得更远。
