儿童先天性胆脂瘤分期手术的残留病变分布与风险分层
Residual disease distribution and risk stratification for staged surgery in pediatric congenital cholesteatoma.
文献信息
| PMID | 42810051 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Riu Nishimura |
| 作者单位 | Department of Otorhinolaryngology-Head and Neck Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan. Electronic address: ri-nisimura@hyo-med.ac.jp. |
| 期刊 | International journal of pediatric otorhinolaryngology |
| SCI 分区 | Q2 |
| IF | 1.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 探讨先天性胆脂瘤（CC）中的残留病变，重点关注其解剖分布，并探索风险分层手术假说。
方法： 在这项回顾性综述中，纳入了2013年1月至2023年7月期间因CC接受手术的72名儿童（72耳；年龄≤15岁）。主要结局为初次手术后残留病变的累积发生率，采用Kaplan-Meier法估计并按Potsic分期分层，以及残留胆脂瘤的解剖分布和残留病变的危险因素。
结果： 在至少随访3年的58耳中，残留病变的累积发生率按Potsic分期差异显著（1-4期分别为8.3%、20.0%、26.7%和47.6%；log-rank p = 0.022；4期与1-3期比较p = 0.004）。在计划的分期二次手术中，31.7%（13/41）的耳发现残留胆脂瘤。在19个残留部位中，14个（74%）聚集在镫骨和鼓室窦周围。Potsic 4期（乳突延伸）是残留病变的显著危险因素（OR，5.00；95% CI，1.54-16.26；p = 0.005）。
结论： Potsic 4期以及镫骨或鼓室窦受累是残留病变的显著危险因素。我们提出一个作为前瞻性评估假说的风险分层方法，即对伴有乳突延伸或镫骨或鼓室窦受累、术中无法确认清除的高风险耳优先进行计划的分期二次手术，而在选定的低风险病例中可能可以避免常规再探查。
英文摘要
OBJECTIVE: To investigate residual disease in congenital cholesteatoma (CC), focusing on its anatomical distribution, and to explore a risk-stratified surgical hypothesis.
METHODS: In this retrospective review, 72 children (72 ears; age ≤15 years) who underwent surgery for CC between January 2013 and July 2023 were included. The main outcomes were the cumulative incidence of residual disease after the initial surgery, estimated using the Kaplan-Meier method and stratified by Potsic stage, the anatomical distribution of residual cholesteatoma, and risk factors for residual disease.
RESULTS: Among 58 ears with at least 3 years of follow-up, the cumulative incidence of residual disease differed significantly by Potsic stage (8.3%, 20.0%, 26.7%, and 47.6% for stages 1-4, respectively; log-rank p = 0.022; p = 0.004 for stage 4 vs. stages 1-3). Residual cholesteatoma was identified at the planned second-stage surgery in 31.7% (13/41) of ears. Of the 19 residual sites, 14 (74%) clustered around the stapes and tympanic sinus. Potsic stage 4 (mastoid extension) was a significant risk factor for residual disease (OR, 5.00; 95% CI, 1.54-16.26; p = 0.005).
CONCLUSIONS: Potsic stage 4 and involvement of the stapes or tympanic sinus were significant risk factors for residual disease. We propose, as a hypothesis for prospective evaluation, a risk-stratified approach in which planned second-stage surgery is prioritized for high-risk ears with mastoid extension or stapes or tympanic sinus involvement, where intraoperative clearance cannot be confirmed, whereas routine re-exploration may be avoidable in selected low-risk cases.