胆汁腺腫の再発 - 33年以上の1,006人の患者を含むレトロスペクティブ研究

Recurrence of Cholesteatoma - A Retrospective Study Including 1,006 Patients for More than 33 Years.

• Patrick Rønde Møller
• Christina Nygaard Pedersen
• Line R Grosfjeld
• Christian E Faber
• Bjarki D Djurhuus

抄録

胆嚢腫は皮膚からなる良性の腫瘍で、鼓膜の引っ込みポケット内に発生します。胆石腫は中耳全体を占めることがあり、その骨溶解能力で知られています。胆石腫の治療は手術が唯一の根治的治療法である。 1983年から2015年までの間にフネン島で初めて外科的治療を受けた中耳コレステアトーマ（STMEC1）の再発リスクを記述すること。 STMEC1の症例は、デンマーク国立病院登録簿で同定した。医療記録を検討した。時間経過分析を適用した。STMEC1から二次性胆汁腺腫、移住、死亡、追跡調査終了までの耳の追跡調査を行った。 STMEC1を有する1,006人の患者の記録を検討した。合計54人の患者が両耳の手術を受けた。総サンプルはSTMEC1を有する1,060例の耳から構成され、300例が小児（16歳未満）の耳、760例が成人の耳であった。観察期間は12,049年であった。術後5年後に再発した割合は、小児で37％、成人で15％であった。最初の手術時の年齢が高い小児ほど、リスクは1年ごとに7％減少した。 成人と比較して、小児の再発リスクは2.6倍高かった。乳房切除術を行わなかった場合の再発リスクは最も低かった。小児では、乳房切除術は再発リスクが有意に低かった。しかし、患者は手術のアプローチに関してランダム化されていなかった；したがって、アプローチと再発リスクの関連は交絡因子の影響を受けている可能性が高い。

 Cholesteatomas are benign tumors consisting of skin, and growing inside a retraction pocket in the tympanic membrane. Cholesteatomas can occupy the entirety of the middle ear, and are known for their osteolytic capabilities. Surgery is the only curative treatment for cholesteatomas.  To describe the risk of recurrence after first-time surgically-treated middle-ear cholesteatoma (STMEC1) on the island of Funen from 1983 to 2015.  Cases of STMEC1 were identified in the Danish National Hospital Register. The medical records were reviewed. Time-to-event analyses were applied. The ears were followed from STMEC1 to a secondary cholesteatoma, emigration, death, or end of follow-up.  Records from 1,006 patients with STMEC1 were reviewed. A total of 54 patients were submitted to surgery on both ears. The total sample consisted of 1,060 ears with STMEC1; 300 were children's (< 16 years) ears, and 760 were adult's ears. The total observation time was of 12,049 years. The overall estimated proportion with recurrence 5 years after surgery was of 37% in children and of 15% in adults. The older the child was at the first surgery, the risk decreased by 7% per year. In children, canal wall up (CWU) mastoidectomy without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% confidence interval [95%CI]: 1.2-3.0) compared with CWU with obliteration.  Compared with adults, children were had 2.6 times more risk of recurrence. Procedures performed without mastoidectomy had the lowest risk of recurrence. In children, obliteration was associated with a significantly lower risk of recurrence. However, patients were not randomized regarding the surgical approach; thus, the association between approach and risk of recurrence was likely influenced by confounding factors.