儿童耳前窦道切除术的结局——窦道切除术与耳上入路的比较

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中文摘要

引言： 耳前窦道是常见的先天性异常，可导致反复感染。多种手术技术被用于切除这些窦道，包括单纯窦道切除术和范围更广的耳上入路。本研究旨在比较儿童人群中窦道切除术与耳上入路切除术的结局。
方法： 在一家三级儿童转诊中心开展了一项回顾性队列研究。识别了2009—2025年期间的病例并审查了临床记录。对窦道切除术与耳上入路之间的数据进行了汇总和分析。使用统计学检验确定显著性。采用多变量Firth惩罚逻辑回归评估不同手术入路及手术辅助措施下的复发情况。
结果： 共纳入63例患者（71耳；平均年龄6.9岁）：37例（52.1%）接受窦道切除术，34例（47.9%）接受耳上入路切除术。术后并发症在窦道切除术组为37例中的12例（32.4%），在耳上入路组为34例中的4例（11.8%）（比值比[OR] 3.6，p < 0.05）。复发分别发生于37例中的9例（24.3%）与34例中的2例（5.9%）（OR 5.14，p < 0.05）。耳上入路（校正OR 0.14，95%置信区间[CI] 0.02—0.68）和软骨切除（校正OR 0.20，95% CI 0.04—0.82）与较低的复发独立相关。
结论： 在本儿童系列中，与窦道切除术相比，耳上入路切除术与较低的复发率和并发症率相关。分析提示，软骨切除可能独立促成较低的复发，并且这种与手术入路的关联在调整手术辅助措施后仍然存在。我们推荐将耳上入路作为儿童复发性或有症状耳前窦道的首选技术。

英文摘要

INTRODUCTION: Preauricular sinuses are common congenital anomalies that can lead to recurrent infections. Various surgical techniques, including simple sinusectomy and the more extensive supra-auricular approach, are used to excise these tracts. This study aimed to compare the outcomes of sinusectomy vs supra-auricular excision in a paediatric population.
METHODS: A retrospective cohort study was conducted at a tertiary paediatric referral centre. Cases from the period 2009-2025 were identified and clinical records were reviewed. Data were compiled and analysed between the sinusectomy and supra-auricular approaches. Statistical tests were used to identify significance. Multivariable Firth penalised logistic regression was used to assess recurrence according to surgical approach and operative adjuncts.
RESULTS: A total of 63 patients (71 ears; mean age 6.9 years) were included: 37 (52.1%) underwent sinusectomy and 34 (47.9%) supra-auricular excision. Postoperative complications occurred in 12 of 37 (32.4%) sinusectomy cases vs 4 of 34 (11.8%) supra-auricular cases (odds ratio [OR] 3.6, p < 0.05). Recurrence occurred in 9 of 37 (24.3%) vs 2 of 34 (5.9%) cases, respectively (OR 5.14, p < 0.05). The supra-auricular approach (adjusted OR 0.14, 95% confidence interval [CI] 0.02-0.68) and cartilage excision (adjusted OR 0.20, 95% CI 0.04-0.82) were independently associated with lower recurrence.
CONCLUSIONS: In this paediatric series, supra-auricular excision was associated with lower recurrence and complication rates than sinusectomy. Analysis suggests that cartilage excision may independently contribute to lower recurrence and this association with surgical approach persists after adjustment for operative adjuncts. We recommend the supra-auricular approach as the preferred technique for recurrent or symptomatic preauricular sinuses in children.