乳突填塞联合外耳道后壁保留鼓室乳突切除术：一项系统综述。
Mastoid Obliteration in Addition to the Canal Wall Up Tympanomastoidectomy: A Systematic Review.
文献信息
| PMID | 42771949 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Chiara Erfurt |
| 作者单位 | Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. |
| 期刊 | Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology |
| SCI 分区 | Q2 |
| IF | 1.9 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 本系统综述旨在总结外耳道后壁保留（CWU）鼓室乳突切除术联合或不联合填塞技术在手术胆脂瘤治疗中的临床、患者相关和经济结局的现有证据。
方法： 在PubMed、Embase、Cochrane、Scopus、ClinicalTrials.gov和EU Clinical Trials Register中进行了全面检索。还检索了NHS EED数据库以获取经济学评价。所有检索均于2025年7月7日完成。纳入标准为在成人中评估填塞技术联合CWU或将其与不联合填塞的CWU进行比较的研究。主要结局是复发/残留疾病。次要结局包括听力结果、并发症、生活质量和经济学评价。两位作者独立筛选并纳入文献；质量评估由所有作者评估并通过共识确定。
结果： 四项比较性研究和五项非比较性回顾性研究涉及主要结局。除一篇文章外，所有文章均报告了手术并发症。另外三项研究关注次要结局：两项关于生活质量，一项关于听力。未发现关于经济学评价或成本分析的研究。此外，未发现前瞻性研究或随机对照试验。
结论： 几乎所有纳入研究的结果表明，在CWU入路基础上增加填塞技术可降低再发率。然而，目前尚无高级别证据研究，且现有研究很可能存在混杂因素。此外，研究间的显著异质性限制了现阶段得出明确结论的能力。
英文摘要
PURPOSE: This systematic review aimed to summarize the available evidence on clinical, patient-related, and economic outcomes of the canal wall up (CWU) tympanomastoidectomy, with and without the obliteration technique in surgical cholesteatoma care.
METHODS: A comprehensive search was conducted in PubMed, Embase, Cochrane, Scopus, ClinicalTrials.gov, and the EU Clinical Trials Register. The NHS EED database was also searched for economic evaluations. All searches were completed by July 7, 2025. Studies were included if they evaluated the obliteration technique alongside CWU or compared it to CWU without obliteration in adults. The primary outcome was recurrent/residual disease. Secondary outcomes included hearing results, complications, quality of life, and economic evaluations. Two authors independently screened and included the literature; quality assessment was assessed by all authors and determined by consensus.
RESULTS: Four comparative and 5 noncomparative retrospective studies addressed the primary outcome. Surgical complications were reported in all but one of the articles. Three additional studies focused on secondary outcomes: 2 on quality of life and 1 on hearing. No studies were identified on economic evaluations or cost analyses. Furthermore, no prospective studies or randomized controlled trials were found.
CONCLUSION: The results of nearly all included studies indicate a reduction in recidivism rates when the obliteration technique is added to the canal wall up (CWU) approach. However, no high-level evidence studies are currently available, and the existing studies are likely subject to confounding factors. In addition, significant heterogeneity among the studies limits the ability to draw definitive conclusions at this stage.