耳内镜下治疗耳胆脂瘤

目的 探讨耳内镜下治疗耳胆脂瘤疾病的优越性和局限性。方法 利用耳内镜对29例(33耳)外耳道胆脂瘤、胆脂瘤型中耳炎、胆脂瘤型中耳炎术后复发或残留、听神经瘤术后并发胆脂瘤的患者进行治疗。结果 经随访3-14个月，共治愈26例(30耳)，3例(3耳)好转，治愈率90．9％(30／33耳)。结论 耳内镜下治疗外耳道胆脂瘤疾病较它法具有明显的优越性，而在治疗胆脂瘤型中耳炎或其术后复发、残留的患者中仍有局限性。但对无法接受手术的病例耳内镜下治疗可减缓或阻止疾病的进一步发展，具有一定的意义。     

耳内镜下不同分期外耳道胆脂瘤手术的疗效分析北大核心CSCD

目的探讨耳内镜下经外耳道处理不同分期外耳道胆脂瘤的手术方法、术后效果。方法以2016年1月至2019年1月26例外耳道胆脂瘤患者为研究对象,其中,Udayabhanu重新分期Ⅰ期4例,Ⅱ期19例,ⅢA期3例,均在耳内镜下完成手术,Ⅰ期及Ⅱ期仅有外耳道骨质破坏者行外耳道胆脂瘤摘除术;Ⅱ期仅侵及鼓膜者行鼓膜成形术,Ⅱ期侵及鼓室者行鼓室成形术、人工听骨植入、外耳道重建;ⅢA期侵及乳突腔的行乳突开放、鼓室成形及外耳道后壁重建。随访9~32个月,观察各组结果。结果26例患者随访过程中均无胆脂瘤复发,无二次手术,术后1个月干耳,仅1例术后外耳道膜性闭锁,10%硝酸银溶液反复灼烧后再通。Ⅰ期患者手术前后平均气导听阈分别为33.18±2.01、11.65±1.40 dB HL,差异有统计学意义(t=16.176,P=0.001),平均气骨导差分别为15.15±1.53、0.95±1.17 dB,差异有统计学意义(t=12.399,P=0.001);Ⅱ期患者手术前后平均气导听阈分别为46.80±6.63、28.03±4.32 dB HL,差异有统计学意义(t=18.752,P<0.001),平均气骨导差分别为27.67±4.98、11.01±3.33 dB,差异有统计学意义(t=16.912,P<0.001);ⅢA期患者手术前后平均气导听阈分别为56.23±6.47、32.87±1.50 dB HL,差异有统计学意义(t=22.635,P=0.002),平均气骨导差分别为32.87±1.50、17.9±4.36 dB,差异有统计学意义(t=7.178,P=0.019)。结论耳内镜下Ⅰ、Ⅱ期外耳道胆脂瘤手术患者术后恢复快,听力提高明显,ⅢA期患者在严格评估适应症的条件下,亦可取得良好的治疗效果。     

耳内镜下手术治疗上鼓室胆脂瘤型中耳炎

目的：探讨提高局限于上鼓室的胆脂瘤型中耳炎疗效的手术方法。方法：对32例(32耳)局限于上鼓室的胆脂瘤型中耳炎患者行内镜下微创手术治疗。结果：32例中，28例1个月内干耳，15例术后听力提高，13例鼓膜穿孔愈合。结论：耳内镜下微创手术治疗局限于上鼓室的胆脂瘤型中耳炎，早期治疗，彻底清除病灶，可阻止胆脂瘤的进一步发展，防止并发症的发生。     

耳内镜技术在中耳胆脂瘤手术中的应用策略

中耳胆脂瘤的手术方式在经历了对中耳生理学、胆脂瘤的生物学特性的不断了解和认识,经由一代又一代耳科医生的修正和改良过程后,日臻成熟与完善。但仍有不尽如人意之处。例如,避免开放式手术的同时,如何提高病灶清除率;如何降低术后胆脂瘤复发率等核心问题。耳内镜技术,与显微镜技术相比,有其独一无二的优势,将耳内镜技术引入中耳胆脂瘤外科治疗过程中是必然的趋势,它的介入有助于清除隐匿病灶和保留耳道内正常结构。本文主要针对耳内镜技术在中耳胆脂瘤外科治疗中的使用方法和手术治疗策略进行简要的概述和介绍。     

耳内镜在治疗外耳道胆脂瘤的临床应用

目的 探讨耳内镜下治疗外耳道胆脂瘤的优越性.方法 利用耳内镜对35例外耳道胆脂瘤患者进行治疗.结果 35例中治愈33例(94.3%),无效复发2例(5.7%),有效率为94.3%.结论 在耳内镜下治疗外耳道胆脂瘤具有视野图像清晰、操作简便、损伤小等优点,值得推广.     

硬质耳内镜在胆脂瘤中耳炎手术治疗中的应用

目的探讨耳内镜在胆脂瘤中耳炎手术治疗中的作用。方法2003—2005年的中耳胆脂瘤患者43例43耳,应用硬性耳内镜协助下行乳突根治 Ⅰ期鼓室成形术,并在耳内镜下随访2年以上(平均2.211±0.323年)。结果术后1.5～3月干耳40例,鼓膜色泽正常。2例内陷袋形成,术后1年经耳内镜手术探查,发现为中耳粘连导致上中鼓室通气不畅。1例术后0.5年因患耳流脓再次手术,为修补之鼓膜与鼓窦口上皮粘连,后鼓室有孤立胆固醇肉芽肿,清除粘连及病变组织后2月干耳。随访测听结果:听力提高10～20dB21耳,21～30dB15耳,>30dB4耳,<10dB3耳。结论耳内镜能够弥补耳显微镜的不足,辅助清除中耳病灶以增加手术成功率。     

持续灌流与非灌流切换结合模式的耳内镜下中耳胆脂瘤手术

目的 本文旨在探索持续灌流模式在耳内镜手术中应用的最佳方式,以及尝试建立持续灌流与非灌流模式切换结合的耳内镜中耳胆脂瘤手术流程.方法 回顾性分析在2019年1月至2020年12月间收治的73名单侧的中耳胆脂瘤患者,术中确定为中上鼓室胆脂瘤患者,年龄为10-68岁,其中女性患者34名,男性患者39名.其中33名患者采用持...     

耳内镜下儿童中耳胆脂瘤的处理及疗效分析

目的 探讨耳内镜下经耳道径路切除儿童中耳胆脂瘤的手术适应证及临床疗效,为该类疾病的处理提供临床参考.方法 回顾性分析2017年9月-2020年10月上海交通大学医学院耳科学研究所耳内镜下经耳道径路处理的20例中耳胆脂瘤患儿临床资料,患者年龄3～14岁,平均年龄为(7±0.5)岁.根据术前影像学评估,病变范围均在中耳范围...     

全耳内镜下中耳乳突部胆脂瘤手术的短期效果观察

目的探讨经外耳道全耳内镜下处理中耳乳突部胆脂瘤的可行性和有效性。方法回顾性分析2019年9月至2020年5月收治的32例累及乳突的胆脂瘤患者经外耳道全耳内镜下的手术临床资料。结果32例患者气导平均听阈术前为56.52±4.89dB HL,术后6月为38.49±3.82)dBHL,差异有统计学意义(t=22.59,P=0.00);平均气骨导距术前为31.45±4.52dBHL,术后6月为17.36±5.14 dBHL,差异有统计学意义(t=15.35,P=0.00)。所有患者鼓膜愈合良好,人工听骨无外露脱出,无面瘫、无眩晕,无听力进一步下降。结论经外耳道入路全耳内镜下乳突部手术术后患者听力较前提高,是安全有效的手术方式。     

耳内镜下冲洗治疗胆脂瘤型中耳炎

目的 探讨采用耳内镜直视下冲洗抽吸法治疗胆脂瘤型中耳炎的效果。方法 27例胆脂瘤型中耳炎采用耳内窦镜直视下冲洗吸引法治疗并根据自身治疗前后疗效对照评分。结果 3个月后复查，23例干耳，4例中耳腔有少许脓性分泌物。结论 耳内镜直视下能比较准确、全面地观察和清洗中耳鼓室内胆脂瘤物质，是耳科临床治疗的一种有效的辅助治疗方法。     

Endoscopic versus microscopic approach in attic cholesteatoma surgery

Purpose

Compare the outcomes of primary exclusive endoscopic ear surgery with those of the microscopic ear surgery in a group of patients affected by attic cholesteatoma.

Endoscopic ear surgery

ObjectivesThis article reviews the advantages and disadvantages of endoscopic ear surgery (EES).MethodPubmed, Google and the Proquest Central Database at Kırıkkale University were queried using the keywords “endoscopic ear surgery”, “ear surgery” and “endoscopy” to identify the literature needed for the review.ResultsEndoscopes allow for enhanced surgical visualisation. The distal part of the apparatus is illuminated and contains lenses angled to allow a wider view of the operative area. Transcanal endoscopic techniques have transformed the external ear canal (EAC) into an operative gateway. The benefits EES can offer include wider views, enhanced imaging capabilities and increased magnification, and ways to see otherwise poorly visualisable portions of the middle ear. EES permits surgeons to operate using minimally invasive otological techniques. When compared with microscope-assisted surgery, endoscopic tympanoplasty has been shown to require a shorter operating time in some instances. There are a number of drawbacks to EES, however, which include the fact that it is a single-handed technique, that the light source may produce thermal injury and that visualisation using the endoscope is severely curtailed if bleeding is profuse.ConclusionEES is a safe and effective technique. The current literature supports the idea that the results achieved by endoscopic methods are usually comparably beneficial to results obtained using conventional microscopic methods.     

Endoscopic management of limited attic cholesteatoma

OBJECTIVES: Microscopic postauricular tympanomastoidectomy provides a limited exposure to the attic, especially anteriorly. In contrast, the endoscope offers wide transcanal access to the attic, allowing for complete removal of limited attic disease, possibly without interrupting the ossicular chain. This report evaluates 8 years of experience with transcanal endoscopic management of limited attic cholesteatoma. STUDY DESIGN: Case series. METHODS: Seventy-three ears with limited attic cholesteatoma underwent endoscopic transcanal tympanotomy and extended atticotomy to access and completely remove the sac. Disease was dissected off the tegmen, the medial and lateral attic walls, and the ossicles. Appropriate ossicular reconstruction was performed. The defect was reconstructed with a composite tragal graft. RESULTS: A transcanal endoscopic approach was adequate for removal of disease in all cases. There were no iatrogenic facial nerve injuries. Bone thresholds were stable. Disease was dissected off the head of the malleus and the body of incus with preservation of both in 24 ears. Mean follow-up was 43 months. Five ears required revision for recurrent disease, and eight were revised for failed ossicular reconstruction or persistent perforation. Moderate to severe retraction in other areas of the tympanic membrane was evident in 28 cases; none of these required further intervention. CONCLUSION: An endoscopic technique allows transcanal, minimally invasive, eradication of limited attic cholesteatoma. Preservation of the ossicles coupled with complete removal of disease is more likely with the endoscope.     

胆脂瘤中耳炎术后复发或残留胆脂瘤的原因与处理

目的:探讨胆脂瘤中耳炎术后复发或残留胆脂瘤的原因和处理方法.方法:对102例(105耳)中耳胆脂瘤术后复发或残留患者分别进行处理.20耳经耳内镜下清理残留或复发的胆脂瘤,切除肉芽;85耳行乳突再根治术.结果:全部患者随访1年以上,101耳于处理后2～8周获得干耳,4耳仍间断流脓;全部患者耳内镜复查均未见胆脂瘤复发.其中23耳同期行鼓室成形术,术后气导听力均提高15 dBHL以上.结论:首次手术不彻底或术后引流不畅是胆脂瘤复发或残留的主要原因.对于面神经嵴够低,乳突、鼓窦、鼓室骨质开放足够、引流好者经耳内镜下清理、换药可痊愈;对于面神经嵴过高,引流不畅者需行乳突再根治,符合条件者可同期行鼓室成形术.     

Endoscopic and minimally-invasive ear surgery: A path to better outcomes

The development of endoscopic ear surgery techniques promises to change the way we approach ear surgery. In this review paper, we explore the current evidence, seek to determine the advantages of endoscopic ear surgery, and see if these advantages are both measureable and meaningful. The wide field of view of the endoscope allows the surgeon to better visualize the various recesses of the middle ear cleft. Endoscopes make it possible to address the target pathology transcanal, while minimizing dissection or normal tissue done purely for exposure, leading to the evolution of minimally-invasive ear surgery and reducing morbidity. When used in chronic ear surgery, endoscopy appears to have the potential to significantly reduce cholesteatoma recidivism rates. Using endoscopes as an adjunct can increase the surgeon's confidence in total cholesteatoma removal. By doing so, endoscopes reduce the need to reopen the mastoid during second-look surgery, help preserve the canal wall, or even change post-cholesteatoma follow-up protocols by channeling more patients away from a planned second-look.     

Role of endoscopy in surgical management of cholesteatoma: A systematic review

Endoscopes are increasingly being used in cholesteatoma surgeries either as an adjunct to microscopes or sometimes exclusively. Their role at present is more as adjunct to microscope which still remains the work-horse for mastoidectomy. However, as endoscopy and endoscopic instruments are increasingly getting refined, role of endoscopy in management of cholesteatoma is continuously being appraised with progressively newer studies. This review aims to assess outcomes of several studies in which endoscopic techniques were used in cholesteatoma surgery and recognize common trends. An extensive review of literature on this theme was performed. Sixteen studies comprising of 1685 patients treated endoscopically either exclusively or in combination with microscope were included. Intra-operatively, in 267 (15.82%) cases, residual cholesteatoma was identified by endoscope in hidden areas after completion of surgery with microscope. On follow-up, recidivism was identified in 108 cases (6.4%) in second look procedures. Common sites of recurrence were hidden areas like sinus tympani. This review while acknowledging the value of microscope, highlights the merit of endoscope usage in cholesteatoma surgery and its role in reducing recurrence.