儿童中耳胆脂瘤47例手术术式及效果分析  

Pediatric surgery for middle ear cholesteatoma:analysis of 47 cases

作　　者：陈梦珂 孙皓洁 任冬冬 Chen Mengke;Sun Haojie;Ren Dongdong(School of Health Science and Engineering,University of Shanghai for Science and Technology,Shanghai 200093,China;Department of Otology and Skull Base Surgery,Eye and ENT Hospital of Fudan University,Shanghai Auditory Medical Center,National Health Commission Key Laboratory of Auditory Medicine,Shanghai 200031,China)

机构地区：[1]上海理工大学健康科学与工程学院,上海200093 [2]复旦大学附属眼耳鼻喉科医院耳神经颅底外科,上海市听觉医学临床中心,国家卫生健康委员会听觉医学重点实验室,上海200031

出　　处：《中华医学杂志》2024年第48期4413-4416,共4页National Medical Journal of China

基　　金：国家自然科学基金面上项目(82271166);上海市自然科学基金(22ZR1410100)。

摘　　要：前瞻性纳入2021年1月至2024年2月于复旦大学附属眼耳鼻喉医院治疗的47例(52耳)中耳胆脂瘤患儿,男30例,女17例,年龄(8.5±2.8)岁。手术方式包括耳内镜下鼓室成形术(29耳),双镜联合鼓室成形术(8耳)及显微镜鼓室成形术(15耳)。耳内镜术后平均气导听阈[(28.4±10.4)分贝听力级(dB HL)比(40.2±14.0)dB HL]、平均骨导听阈[(12.4±5.9)dB HL比(16.3±6.8)dB HL]和气骨导差[(16.0±6.3)dB HL比(23.9±9.8)dB HL]均较术前改善(均P<0.05)。术后平均气导听阈及气骨导差三组间差异均有统计学意义,且耳内镜组低于显微镜组和双镜联合组(均P<0.05)。随访5.6(1.2,11.5)个月,耳内镜和显微镜手术患儿鼓膜愈合情况差异无统计学意义(P=0.747)。耳内镜组1耳术后3年复发,未发生颅内外并发症。研究结果提示,儿童胆脂瘤耳内镜下鼓室成形术改善听力效果良好。The clinical data of 47 children(52 ears)with middle ear cholesteatoma at Eye&ENT Hospital,Fudan University from January 2021 to February 2024 were prospectively collected.There were 30 males and 17 females,with a mean age of(8.5±2.8)years.Surgical procedures included endoscopic tympanoplasty(29 ears),combined endoscopic/microscopic tympanoplasty(8 ears)and microscopic tympanoplasty(15 ears).After endoscopic surgeries,the mean air conduction hearing threshold,mean bone conduction hearing threshold and air bone gap were(28.4±10.4)dB HL,(12.4±5.9)dB HL and(16.0±6.3)dB HL,respectively,which were significantly improved compared with preoperative indicators[(40.2±14.0)dB HL,(16.3±6.8)dB HL and(23.9±9.8)dB HL,respectively](all P<0.05).There were statistically significant differences in the postoperative mean air conduction hearing threshold and air bone gap among three surgical groups,and the value of endoscope group was lower than those of microscope group and endoscope combined with microscope group(all P<0.05).After a follow-up of 5.6(1.2,11.5)months,no statistically significant differences were observed in the rate of successful tympanic membrane healing between endoscope group and microscope group(P=0.747).One ear in the endoscope group experienced recurrence three years after surgery,and no intracranial and extracranial complications occurred.The current study indicates that endoscopic surgery for pediatric cholesteatoma improves hearing with good results.

关 键 词：胆脂瘤 中耳 儿童 耳内镜 显微镜 

分 类 号：R76[医药卫生—耳鼻咽喉科]