鼓室成形术中常规切除脐部是否必要？一项组织病理学与临床研究。
Is Routine Umbo Resection Necessary During Over-Underlay Tympanoplasty? A Histopathological and Clinical Study.
文献信息
| PMID | 42830259 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Emrah Gündüz |
| 作者单位 | Department of Otorhinolaryngology Head and Neck Surgery, Inonu University Faculty of Medicine, Malatya, Turkey. |
| 期刊 | Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery |
| SCI 分区 | Q2 |
| IF | 2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 在over-underlay鼓室成形术中常规切除脐部的必要性仍存在争议。
目的： 根据穿孔与脐部的关系评估上皮残余的组织病理学持续存在情况，并估计术后胆脂瘤的风险。
方法： 前瞻性队列研究，纳入148例连续接受I型over-underlay鼓室成形术的患者，随访至少24个月。根据穿孔与脐部的关系对患者进行分组。所有切除标本均进行苏木精-伊红（H&E）染色检查；本系列未进行泛细胞角蛋白免疫组化。分类比较采用Fisher精确检验；比例以95%置信区间（CI）报告。胆脂瘤发生率的事后95%置信上限采用泊松近似计算。
结果： 组织病理学显示，第1组上皮残余率为33.3%（12/36；95% CI 18.6-51.0），第2组为21.9%（7/32；95% CI 9.3-40.0）；第3组未检测到上皮残余。平均随访24个月期间未发生胆脂瘤；真实胆脂瘤发生率的95%置信上限为2.02%。
结论： 累及脐部的穿孔与较高的显微镜下上皮残余率相关，但在观察随访期内，显微镜下残余并未转化为胆脂瘤。当能够实现细致的去上皮化时，常规切除脐部并非强制；建议根据术中评估进行选择性切除。需要更长的随访时间和更大的多中心队列以排除罕见不良事件。
英文摘要
BACKGROUND: The necessity of routine umbo resection during over-underlay tympanoplasty remains controversial.
OBJECTIVE: To evaluate histopathological persistence of epithelial remnants according to perforation-umbo relationship and to estimate the risk of postoperative cholesteatoma.
METHODS: Prospective cohort of 148 consecutive Type I over-underlay tympanoplasties with minimum 24-month follow-up. Patients were grouped by perforation relation to the umbo. All resected specimens were examined with haematoxylin-eosin (H&E); pan-cytokeratin immunohistochemistry was not performed in this series. Categorical comparisons used Fisher's exact test; proportions are reported with 95% confidence intervals (CI). Post hoc upper 95% bound for cholesteatoma incidence was calculated using the Poisson approximation.
RESULTS: Histopathology revealed epithelial remnants in 33.3% (12/36; 95% CI 18.6-51.0) of Group 1 and 21.9% (7/32; 95% CI 9.3-40.0) of Group 2; none were detected in Group 3. No cholesteatoma developed during mean follow-up of 24 months; the upper 95% confidence bound for true cholesteatoma incidence was 2.02%.
CONCLUSION: Umbo-involving perforations are associated with higher rates of microscopic epithelial remnants, but microscopic remnants did not translate into cholesteatoma within the observed follow-up. Routine umbo resection is not mandatory when meticulous de-epithelialisation is achievable; selective resection based on intraoperative assessment is recommended. Longer follow-up and larger multicentre cohorts are required to exclude rare adverse events.