内镜下中耳胆脂瘤手术路径探索

Operative approaches in endoscopic surgery of middle ear cholesteatoma

目的探索内镜下3种手术路径治疗中耳胆脂瘤的临床价值。方法回顾性分析2010年1月-2019年12月203例209耳行中耳胆脂瘤切除术患者的临床资料。其中,85例88耳借鉴"锁孔"理念、吸收显微镜手术技术,通过外耳道-上鼓室-鼓窦-乳突、外耳道-鼓窦-乳突和耳甲艇切口-鼓窦-乳突3个手术路径行内镜下手术入路中耳胆脂瘤切除,118例121耳行显微镜下乳突根治术。比较两组患者手术并发症和术后复发情况。结果所有病例术后随访6~24个月,内镜组干耳率94.32%、显微镜组95.87%;内镜组并发症发生率10.23%、显微镜组12.40%;内镜组残留和复发率6.82%、显微镜组4.13%,两组患者比较,差异均无统计学意义(P<0.05)。结论耳内镜手术可通过3个路径切除涉及整个乳突的中耳胆脂瘤,拓展了中耳胆脂瘤手术的治疗范围。

Objective To explore the clinical value of three approaches for endoscopic resection of cholesteatoma in the middle ear.Methods clinical data of 203 patients underwent middle ear cholesteatoma resection from January 2010 to December 2019 were retrospectively analyzed.Among them,The concept of"lock hole"and the surgical technique of absorption microscope were used in 88 ears of 85 cases,the middle ear cholestatoma was removed by endoscopic surgical approach through three surgical approaches:external auditory meatus-attic-tympanum-mastoidprocess,external auditory meatus-tympanum-mastoid process and auricular vessel incision-tympanum-mastoid process,and 121 ears of 118 cases received radical mastoid surgery under microscope.Surgical complications and postoperative recurrence were compared between the two groups.Results The mean postoperative follow-up period was 6~24 months.Between the endoscopic group and the microscopic group,there were no statistically significant differences in dry ear rate(94.32 vs 95.87%),surgical complication rate(10.23%vs 12.40%),residual and recurrent rate(6.82%vs 4.13%).Conclusion Endoscopic ear surgery can remove cholesteatoma of the middle ear involving the entire mastoid process through three approaches,expanding the scope of surgical treatment of cholesteatoma of the middle ear.