小儿胆脂瘤型中耳炎的鼓室成形术

Tympanoplasty for cholesteatoma in pediatric patients

目的探讨小儿胆脂瘤型中耳炎鼓室成形术最佳手术治疗策略。完壁式鼓室成形术和伴乳突根治的鼓室成形术作为治疗胆脂瘤型中耳炎的不同乳突处理方法,探讨其各自适应证及术后效果。方法对1997年4月—2003年10月间入院手术的4～14岁的胆脂瘤型中耳炎患者42例(45耳)的完整资料进行回顾性分析。随访时间为1～7年,平均(3.6±2.0)年。结果首次手术以完壁式鼓室成形术作为治疗方法的有20例(20耳),再发6耳,再发率30%,听力改善率77%(13/17);有22例(25耳)进行了伴乳突根治的鼓室成形术,再发1耳,再发率4%,听力改善率72%(18/25)。结论完壁式鼓室成形术具有保存生理性外耳道结构的优点,更有利于小儿胆脂瘤型中耳炎的治疗,但应常规行分期手术,克服易复发的缺点;对于分期手术时咽鼓管机能仍然较差者,建议改行伴乳突根治的鼓室成形术术式。

Objective To discuss the best strategy in tympanoplasty for cholesteatoma in pediatric patient. Both intact canal wall mastoidectomy with tympanoplasty （ICW） and canal wall down mastoidectomy with tympanoplasty（CWD） were the basic technique for cholesteatoma in pediatric patient. The outcomes of ICW and CWD as comparisons of different surgical technique were assessed. Methods A retrospective analysis of all cases of pediatric primary acquired cholesteatoma aged 4-14 years old between April, 1997 and October, 2003 was conducted. The follow-up information was completed. Forty-two patients （45 ears） were treated and followed from 1 to 7 years [ the average is （3.6 ± 2.6） years ]. Results ICW was the primary surgical treatment in 20 patients （20 ears） initially, the recidivism rate was 30% （6/20）, the achieved rate of pure-tone threshold average （ PTA ） was 77% （ 13/17 ） ; Twenty-five （ two ） patients （45 ears） underwent CWD , the recidivism rate was 4% （ 1/25 ）, the achieved rate of PTA was 72% （ 18/25 ）. Conclusions ICW had the advantage which could preserve the physical structure of the external acoustic meatus and had more profits for the treatment of cholesteatoma in pediatric patients, but it should be done for planned second stage surgery as a routine method that could get over the defect of recrudescence. If the function of eustachian tube was still not normal when planned second stage surgery operation was done, the CWD was suggested instead .