小龄儿童全耳内镜中耳胆脂瘤手术可行性分析

Feasibility analysis of transcanal totally endoscopic surgery for middle ear cholesteatoma in young children

目的探讨小龄儿童经耳道全耳内镜中耳胆脂瘤手术可行性,提示临床诊疗路径。方法收集2016年4月-2021年3月经耳道全耳内镜手术治疗的小龄(≤6岁)中耳胆脂瘤患儿为研究对象。入组26例患儿,男19例,女7例;年龄1.9~6岁,平均年龄(4.1±0.9)岁。对病例一般资料、病变程度、术中情况、术后并发症、住院时间、复发与否等进行统计学分析,分析小龄儿童经耳道全耳内镜手术可行性及手术策略。结果先天性胆脂瘤21例(80.8%),后天性胆脂瘤5例(19.2%)。EAONO/JOS分期Ⅰ期8例(30.8%),Ⅱ期17例(65.4%),Ⅲ期1例(3.8%)。12例术中使用角度镜。术中出血1.0(1.0,2.0)mL,手术时长85.0(50.0,110.0)min,术后住院2.0(2.0,5.0)d。术后3例患儿有短期眩晕,1例暂时性轻度面部运动不对称,鼓索神经术中均有游离,无其他并发症。复发1例。结论小龄儿童中耳胆脂瘤可实施耳道全耳内镜手术,对于病变延伸至后鼓室、上鼓室、鼓窦入口等情况需辅助角度镜。耳内镜对精细结构的观察有明显优势,可有效保护中耳结构。

Objective To explore the feasibility of treatment of middle ear cholesteatoma in young children with transcanal totally endoscopic ear surgery so as to guide the pathway of clinical diagnosis and treatment.Methods The young children(≤ 6 years old) with middle ear cholesteatoma treated by transcanal totally endoscopic surgery in our department from April 2016 to March 2021 were selected as the object of study. The general data, degree of the lesion, intraoperative condition, postoperative complications, hospital stays, and recurrence were statistically analyzed. The feasibility and strategy of transcanal totally endoscopic surgery in young children were analyzed.Results A total of 26 children were included, their average age was 4.1±0.9 years old, and the youngest was 1.9 years old. There were 19 boys(73.1%) and 7 girls(26.9%). Of them, 21 cases were congenital cholesteatoma(80.8%) and 5 were acquired cholesteatoma(19.2%). According to EAONO/JOS staging, there were 8 cases of stage Ⅰ(30.8%), 17 cases of stage Ⅱ(65.4%), 1 case of stage Ⅲ(3.8%), and none of stage IV. Multi-angle otoendoscopes were used in 12 cases. The intraoperative bleeding was 1.0(1.0, 2.0) ml. The length of operation was 85.0(50.0, 110.0)minutes, and the postoperative hospital stay was 2.0(2.0, 5.0)days. Intraoperative dissociation of chorda tympani nerve was achieved in all cases. After operation, 3 cases had short-term vertigo, one had temporary mild facial movement asymmetry, and no other complications were found. Recurrence occurred in one.Conclusions Transcanal totally endoscopic ear surgery can be performed for middle ear cholesteatoma in young children. The extension of cholesteatoma to the posterior tympanum, epitympanum, and the entrance of the tympanic sinus requires aid of multi-angle oto-endoscopes for observation. With obvious advantage of clear observation of fine structure, otoendoscope can effectively protect the structure of the middle ear.