Minimally Invasive Functional Approach for Cholesteatoma Surgery
Minimally Invasive Functional Approach for Cholesteatoma Surgery
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DOI：
10.1002/lary.24633
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发表时间：
2014-10-01
期刊：
影响因子：
2.6
通讯作者：
Poe, Dennis
中科院分区：
文献类型：
--
作者：
Hanna, Bassem M.;Kivekas, Ilkka;Poe, Dennis
Objectives/HypothesisReport the efficacy of a functional minimally invasive approach for prosthetic teatomasurgery.Study DesignRetrospective review of surgical cases performed between 1996 and 2008.MethodsOne hundred 69 patient charts were reviewed in which ears with primary prosthetic teatomas that extended outside mesotypanum were operated on with a plan for canal wall up（CWU）mastoidotomy.根据需要，手术方法包括从经鼻到鼓室成形术再到CWU乳突切除术的渐进性暴露，以识别并溶解将囊与周围粘膜结合的纤维附着物。酌情采用内窥镜引导，以尽量减少暴露需求。任何计划的第二阶段的操作，试图与经肛门的方法，如果适当的，并与内窥镜assistance.Results169例患者的184耳。中位年龄为32岁（范围：1-79岁）。平均随访3.2年（范围：1-11年）。83例（45%）计划进行二次手术，3例（2%）需要进行计划外的二次手术。总复发率为24/184（13%），非预期残留率为5/184（3%）。有内镜检查的残留率（5/119，4%）或无内镜检查的残留率（1/65，2%）无显著差异。156耳听力明显改善，由术前纯音平均（PTA）41 dB提高到术后平均29 dB（P
Objectives/HypothesisReport the efficacy of a functional minimally invasive approach for cholesteatoma surgery.Study DesignRetrospective review of surgical cases performed between 1996 and 2008.MethodsOne hundred sixty-nine patient charts were reviewed in which ears with primary cholesteatomas that extended beyond the mesotympanum were operated on with a plan for canal wall up (CWU) mastoidectomy. The surgical approach consisted of progressive exposure from transcanal to postauricular tympanoplasty to CWU mastoidectomy, as needed, to identify and lyse the fibrous attachments that bind the capsule to the surrounding mucosa. Endoscopic guidance was employed as appropriate to minimize exposure needs. Any planned second-stage operations were attempted with a transcanal approach if appropriate and with endoscopic assistance.ResultsOne hundred eighty-four ears of 169 patients were included. The median age was 32 years (range, 1-79 years). The mean follow-up was 3.2 years (range, 1-11 years). Eighty-three (45%) were planned for a second-look operation, and three (2%) required unplanned second operations. The overall recurrence rate was 24/184 (13%), and the unexpected residual rate was 5/184 (3%). The residual rate with endoscopy (5/119, 4%,) or without endoscopy (1/65, 2%), were not significantly different. Hearing results in 156 ears improved significantly, from a preoperative pure-tone average (PTA) of 41 dB to a postoperative PTA average of 29 dB (P