Beijing Children’s Hospital, Capital Medical University, National Center for Children′s Health
目的 探讨小龄儿童经耳道全耳内镜中耳胆脂瘤手术可行性，提示临床诊疗路径。 方法 以我科2016年4月-2021年3月经耳道全耳内镜手术治疗的小龄（≤6岁）中耳胆脂瘤患儿为研究对象。对病例一般资料、病变程度、术中情况、术后并发症、住院时间、复发等进行统计分析。分析小龄儿童经耳道全耳内镜手术可行性及手术策略。 结果 入组26例患儿，年龄4.1±0.9岁，最小1.9岁。男孩19例（73.1%），女孩7例（26.9%）。先天性胆脂瘤21例（80.8%），后天性胆脂瘤5例（19.2%）。EAONO/JOS分期I期7例（26.9%），II期18例（69.2%），III期1例（3.8%），IV期0例。12例术中使用角度镜。术中出血1.0（1.0，2.0）ml。手术时长85.0（50.0，110.0）min，术后住院2.0（2.0，5.0）天。术后3例患儿有短期眩晕，1例暂时性轻度面部运动不对称，鼓索神经术中均有游离，无其他并发症。复发1例。 结论 小龄儿童中耳胆脂瘤可实施耳道全耳内镜手术，对于病变延伸至后鼓室、上鼓室、鼓窦入口等情况需辅助角度镜。耳内镜对精细结构的观察有明显优势，可有效保护中耳结构。
Objective To explore the feasibility of treatment of middle ear cholesteatoma in young children with transcanal totally endoscopic ear surgery, and to guide the path of clinical diagnosis and treatment. Methods The young children (≤ 6 years old) with middle ear cholesteatoma who were treated by surgery via transcanal totally endoscopic in our department from April 2016 to March 2021 were selected as the object of study. The general data, degree of the lesion, intraoperative condition, postoperative complications, hospital stays, and recurrence were statistically analyzed. To analyze the feasibility and strategy of total ear canal endoscopic surgery in young children. Results There were 26 children in the group, the age was 4.1±0.9 years old, and the youngest was 1.9 years old. There were 19 boys (73.1%) and 7 girls (26.9%). There were 21 cases of congenital cholesteatoma (80.8%) and 5 cases of acquired cholesteatoma (19.2%). According to EAONO/JOS staging, there were 7 cases of stage I (26.9%), 18 cases of stage II (69.2%), 1 case of stage III (3.8%), and 0 cases of stage IV. Multi-angle oto-endoscopes were used in 12 cases. The intraoperative bleeding was 1.0（1.0, 2.0） ml. The length of operation was 85.0（50.0, 110.0） minutes, and the postoperative hospital stay was 2.0（2.0, 5.0）days. After an operation, 3 cases had short-term vertigo, 1 case had temporary mild facial movement asymmetry, and no other complications were found. Recurrence occurred in 1 case. Conclusion Total endoscopic otologic surgery can be performed for middle ear cholesteatoma in young children. The extension of cholesteatoma to the posterior tympanic, epitympanum, and the entrance of the tympanic sinus should be observed with the aid of multi-angle oto-endoscopes. Ear endoscope has obvious advantages in the observation of fine structure, which can effectively protect the structure of the middle ear.