初次联合入路鼓室成形术中应用骨泥填塞上鼓室能否减少胆脂瘤复发？
Does Epitympanic Obliteration with Bone Pâté in Primary Combined Approach Tympanoplasty Reduce Cholesteatoma Recurrence?
文献信息
| PMID | 42973395 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Junaid Kalliyath |
| 作者单位 | Department of Otolaryngology, William Harvey Hospital East Kent Hospital University Trust, Kent, UK. |
| 期刊 | The journal of international advanced otology |
| SCI 分区 | Q3 |
| IF | 1.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 胆脂瘤是一种需要手术干预的侵袭性颞骨病变，但复发仍是一大挑战。在初次联合入路鼓室成形术（CAT）中填塞上鼓室在减少复发方面显示出前景。
方法： 对2014年9月至2023年1月期间因胆脂瘤接受初次CAT的110例患者进行了回顾性队列研究。根据2018年6月手术技术的改变，将患者分为非填塞组（n = 56）和填塞组（n = 54）。主要结局为胆脂瘤复发，经翻修CAT术中的术中发现确认。采用Kaplan-Meier生存分析评估无复发生存率。
结果： 填塞组的复发率（5.56%）显著低于非填塞组（30.36%）。这对应于绝对风险降低24.8%、比值比0.13（95% CI：0.04-0.49；P < .005），以及复发 odds 降低87%。填塞组的所有复发病例均为残留病变，而非填塞组则同时可见残留病变（15%）和复发疾病（16%）。Kaplan-Meier分析证实填塞组的无复发生存率更优（P < .001），且获益持续超过60个月。STAMCO III期病变占填塞组所有复发，突显了其在晚期病例中的价值。
结论： 在CAT术中应用骨泥填塞上鼓室可显著减少胆脂瘤复发，尤其是在晚期病变中，应将其视为减少胆脂瘤复发的常规辅助措施。
英文摘要
BACKGROUND: Cholesteatoma is an invasive temporal bone lesion requiring surgical intervention, but recurrence remains a major challenge. Obliteration of the epitympanum during primary combined approach tympanoplasty (CAT) shows promise in reducing recidivism.
METHODS: A retrospective cohort study was conducted on 110 patients who underwent primary CAT for cholesteatoma (September 2014 to January 2023). Patients were divided into a non-obliteration group (n = 56) and an obliteration group (n = 54), based on a change in surgical technique in June 2018. The primary outcome was cholesteatoma recidivism, confirmed by intra-operative findings during revision CAT. Kaplan-Meier survival analysis was used to assess recurrence-free survival.
RESULTS: The obliteration group demonstrated a significantly lower rate of recidivism (5.56%) compared to the non-obliteration group (30.36%). This corresponded to an absolute risk reduction of 24.8%, odds ratio of 0.13 (95% CI: 0.04-0.49; P < .005), and an 87% reduction in odds of recurrence. All cases of recidivism in the obliteration group were residual disease, whereas both residual (15%) and recurrent (16%) disease were seen in the non-obliteration group. Kaplan-Meier analysis confirmed superior recurrence-free survival in the obliteration group (P < .001), with sustained benefit over 60 months. STAMCO stage III disease accounted for all recurrences in the obliteration group, highlighting its value in advanced cases.
CONCLUSION: Bone pâté obliteration of the epitympanum during CAT significantly reduces cholesteatoma recurrence, particularly in advanced disease, and should be considered as a routine adjunct to reduce cholesteatoma recurrence.