获得性胆脂瘤的乳突填塞：上鼓室分隔中手术技术的重要性与演变
Mastoid Obliteration in Acquired Cholesteatoma, Importance and Evolution of Surgical Technique Used in Epitympanic Separation of the Middle Ear.
文献信息
| PMID | 42887011 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Alejandro Sutter |
| 作者单位 | Department of Otorhinolaryngology, Amsterdam UMC, Amsterdam, 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 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 确定在胆脂瘤手术中将上鼓室与中耳分隔的填塞技术对胆脂瘤复发的影响。
研究设计： 三级转诊中心的回顾性队列研究。
患者： 纳入2010年至2023年所有接受胆脂瘤手术的患者。116例儿童，286例成人。142例为初次手术，260例为修正手术。
干预： 采用不同技术行保留外耳道后壁的乳突切除术及上鼓室和乳突填塞。
主要结局指标： 随访期间的复发率及复发时间。
结果： 总体复发率为11.69%（中位随访4.3年，范围0.02至12年）。5种不同填塞技术的复发率差异显著：骨泥填塞后为100%（中位随访3.3年），混合技术后为21%（中位随访2.5年），软骨后为18%（中位随访5.6年），颞中动脉瓣（MTF）后为10%（中位随访4.7年），无活力瓣后为0%（中位随访0.6年，范围至11年）。校正随访时间后，Kaplan-Meier生存曲线中这一统计学显著差异仍然存在。
结论： 为降低保留外耳道后壁手术联合填塞的复发率，重点应在于建立中耳与上鼓室之间完整而平滑的分隔。目前，使用有活力MTF或无活力瓣建立该分隔，随后用羟基磷灰石填充上鼓室剩余空间和乳突，可获得最有利的结果。该效应独立于患者年龄和不同术者等可能混杂因素。当前技术随访时间较短是一项局限；需要更长时间随访以可靠确认其是否比既往技术更有效地减少复发性病变。
英文摘要
OBJECTIVE: To determine the effect of the obliteration technique applied to divide the epitympanum from the middle ear during cholesteatoma surgery on the recurrence of cholesteatoma.
STUDY DESIGN: Retrospective cohort study in a tertiary referral center.
PATIENTS: All patients undergoing cholesteatoma surgery from 2010 until 2023 were included. 116 pediatric cases, 286 adults. One hundred forty-two were primary surgeries, 260 revision procedures.
INTERVENTION: Canal wall up mastoidectomy and obliteration of the epitympanum and mastoid using different techniques.
MAIN OUTCOME MEASURES: Recurrence rates and timing of recurrence during follow-up.
RESULTS: The overall recurrence rate was 11.69% (median FU 4.3 y, range: 0.02 to 12 y). The recurrence rates differed significantly among the 5 different techniques of obliteration: 100% after obliteration with bone pâté (median FU 3.3 y), 21% after a hybrid technique (median FU 2.5 y), 18% after cartilage (median FU 5.6 y), 10% after midtemporal artery flap (MTF, median FU 4.7 y), and 0% after an avital flap (median FU 0.6 y, range up to 11 y). When correcting for FU length, the statistically significant difference persisted in the Kaplan-Meier survival curves.
CONCLUSIONS: To lower recurrence rates in canal wall up surgery with obliteration, the focus should lie in creating a complete and smooth separation of the middle ear from the epitympanum. Currently, the most favorable results are found when this separation is created with a vital MTF or an avital flap, followed by hydroxyapatite to fill up the rest of the epitympanic space and mastoid. This effect is independent of possible confounders such as age of the patient and different surgeons. The short FU for the current technique is a limitation; longer FU is needed to reliably confirm whether it reduces recurrent disease more effectively than previous techniques.