儿童先天性及后天性中耳胆脂瘤临床特征分析  

Clinical characteristics of congenital and acquired middle ear cholesteatoma in children

作　　者：邵剑波 陈敏[1] 郝津生[1] 杨扬[1] 刘薇[1] 刘冰[1] 马宁[1] 张晓 王晓旭 张杰[1] SHAO Jianbo;CHEN Min;HAO Jinsheng;YANG Yang;LIU Wei;LIU Bing;MA Ning;ZHANG Xiao;WANG Xiaoxu;ZHANG Jie(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing,100045,China)

机构地区：[1]国家儿童医学中心、国家临床重点专科、首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京100045

出　　处：《临床耳鼻咽喉头颈外科杂志》2025年第2期133-136,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨儿童先天性中耳胆脂瘤(congenital cholesteatoma,CC)及后天性中耳胆脂瘤(acquired cholesteatoma,AC)临床特征及手术疗效,为临床认识儿童中耳胆脂瘤及手术方式选择、判断预后提供一定的指导意义。方法:回顾性分析2010年1月-2020年7月于首都医科大学附属北京儿童医院耳鼻咽喉头颈外科治疗的169例(176耳)中耳胆脂瘤患儿临床资料,对其临床特点、分期、手术方式及术后复发率情况进行分析总结。结果:(1)入组患儿年龄分布为2~14岁,CC组平均年龄(5.60±2.48)岁,AC组平均年龄(6.45±2.48)岁,差异有统计学意义(P<0.05);(2)术前听力,CC组为(40.06±13.52)dB HL,AC组为(48.40±13.84)dB HL,差异有统计学意义(P<0.05);(3)根据EAONO/JOS胆脂瘤分期:CC组Ⅰ期比例小于AC组,差异有统计学意义(P<0.05);(4)预后:初次手术后复发率,CC为19.23%(10/52),AC为36.29%(45/124),差异有统计学意义(P<0.05);所有手术结束后乳突保留率,CC为28.85%(15/52),AC为5.65%(7/124),差异有统计学意义(P<0.05)。结论:儿童AC相对CC侵袭性更强,并发症更多,且术后复发率高,乳突保留的可能性更小,需要临床早期发现及治疗,手术多考虑开放式鼓室成形术。Objective To retrospectively analyze the clinical features and surgical efficacy of congenital cholesteatoma(CC)and acquired cholesteatoma(AC)in children.Methods Clinical data of 169 children with middle ear cholesteatoma were reviewed in the Department of Otorhinolaryngology Head and Neck Surgery,Beijing Children's Hospital,Capital Medical University from January 2010 to July 2020.The clinical characteristics,stages,surgical methods,and postoperative recurrence rates were analyzed and summarized.Results The age distribution of enrolled children ranged from 2 to 14 years.The mean age of the CC group was(5.60±2.48)years compared with(6.45±2.48)years in the AC group,and the difference was statistically significant(P<0.05).Preoperative hearing in the CC group was(40.06±13.52)dB HL,which was better than in the AC group at(48.40±13.84)dB HL(P<0.05).The proportion of stage Ⅰ in the CC group was lower than that in the AC group according to EAONO/JOS staging(P<0.05).The recurrence rate after primary surgery was 19.23%(10/52)in the CC group compared with 36.29%(45/124)in the AC group(P<0.05).The mastoid retention rates after all operations were 28.85%(15/52)in the CC group and 5.65%(7/124)in the AC group(P<0.05).Conclusion Compared with congenital cholesteatoma,acquired cholesteatoma in children is more aggressive and has more complications,higher postoperative recurrence rate,and less possibility of mastoid retention.Early clinical detection and treatment are required,and canal wall-down tympanoplasty should be considered in surgery.

关 键 词：先天性胆脂瘤 后天性胆脂瘤 手术术式 复发率 儿童 

分 类 号：R764.29[医药卫生—耳鼻咽喉科]