Risk Factors of Recurrence in Pediatric Congenital Cholesteatoma.

Risk Factors of Recurrence in Pediatric Congenital Cholesteatoma.
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小儿先天性胆脂瘤复发的危险因素。

DOI：
10.1097/mao.0000000000001587
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发表时间：
2017
期刊：
Otology and Neurotology
影响因子：
2.1
通讯作者：
A. Horii
A. Horii
中科院分区：
医学2区
文献类型：
--
作者：
Y. Morita;Kuniyuki Takahashi;Shuji Izumi;Yamato Kubota;Shinsuke Ohshima;Yutaka Yamamoto;Sugata Takahashi;A. Horii

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客观的 探讨小儿先天性胆脂瘤复发的危险因素。 研究设计 回顾性图表审查。 环境 大学医院。 患者 15岁以下鼓室型先天性胆脂瘤手术患者67例。 干预措施 根据胆脂瘤的扩展程度，进行耳道上鼓室乳突切除术 (n = 30) 或经耳道鼓室切开术/鼓室成形术 (n = 37)，其中 16 例随后进行了二次手术。复查手术前进行术前计算机断层扫描 (CT) 或术后 CT 随访以检测术后 1 年后的残留复发情况。第二次手术时发现的胆脂瘤也包括在复发范围内。所有患者在最后一次随访时（中位术后 61 个月）均未出现胆脂瘤复发。 主要成果指标 比较各组之间可能的预测因素。 结果 残余胆脂瘤和回缩胆脂瘤的发生率分别为 21% 和 6%。各组之间的年龄、性别和胆脂瘤类型（开放性或闭合性）没有显着差异；然而，残余胆脂瘤组的 Potsic 分期和镫骨受累状态更为晚期。所有残留病灶均可通过后续 CT 或二次手术发现。所有四名回缩性胆脂瘤患者均为男性，手术时年轻，处于 IV 期。 结论 复发大多以残留胆脂瘤形式发生，提示CT值得推荐作为先天性胆脂瘤的随访工具。晚期病变有残留胆脂瘤的风险，表明完全去除上皮很重要。尽管罕见，但年轻的晚期患者存在回缩性胆脂瘤的风险，因此应尽可能保留这些患者的正常粘膜。
OBJECTIVE To examine the risk factors of recurrence in pediatric congenital cholesteatoma. STUDY DESIGN Retrospective chart review. SETTING University hospital. PATIENTS Sixty-seven patients having tympanic type of congenital cholesteatoma under 15-years old at surgery. INTERVENTIONS Canal wall-up tympanomastoidectomy (n = 30) or transcanal atticotomy/tympanoplasty (n = 37) was performed depending on cholesteatoma extension, 16 of which were followed by second-look surgery. Preoperative computed tomography (CT) before second-look surgery or follow-up CT was performed to detect residual recurrence 1 year after the surgery. Cholesteatoma found at the second surgery was also included in the recurrence. All patients had no recurrent cholesteatoma at the last follow-up (median, 61 mo after surgery). MAIN OUTCOME MEASURES Possible predictive factors were compared between the groups. RESULTS Residual cholesteatoma and retraction cholesteatoma occurred in 21 and 6%, respectively. There was no significant difference in age, sex, and type of cholesteatoma (open or closed) between the groups; however, Potsic stage and status of stapes involvement were more advanced in the residual cholesteatoma group. All residual lesions could be detected by follow-up CT or by second-look surgery. All of four retraction cholesteatoma patients were male, young at the surgery and in stage IV. CONCLUSION Recurrence mostly occurred as residual cholesteatoma, suggesting that CT is recommended as a follow-up tool for congenital cholesteatoma. Advanced lesions had the risk of residual cholesteatoma, suggesting that complete removal of epithelium is important. Although rare, young advanced-stage patients had risk of retraction cholesteatoma and therefore normal mucosa should be preserved as much as possible for these patients.