後天性中耳孔胸腺腫の手術成績と病期との相関関係。EAONO/JOS病期分類システムの再検証．

Correlation between Surgical Outcome and Stage of Acquired Middle Ear Cholesteatoma: Revalidation of the EAONO/JOS Staging System.

• Fazıl Necdet Ardıç
• Erdem Mengi
• Funda Tümkaya
• Cüneyt Orhan Kara
• Ferda Bir

抄録

研究の目的:

本研究は、後天性中耳球腺腫手術の術中所見、再発率、聴力成績を評価し、新たに提案されたEAONO/JOS Joint Consensus Statementとの相関関係を検討することを目的とした。

OBJECTIVES: This study aimed to evaluate the intraoperative findings, recurrence rate, and hearing outcome of cholesteatoma surgery and correlate them with the newly proposed EAONO/JOS Joint Consensus Statement.

材料および方法:

2009年から2017年の間に慢性中耳炎と胆汁腺腫と診断された407人の患者の記録をレビューした。手術メモやアナムネシスが不十分な記録を除外した後、353 例の患者を調査対象とした。一次手術を受けた290例と再手術を受けた63例を別々に評価した。

MATERIALS AND METHODS: The records of 407 patients diagnosed with chronic otitis media and cholesteatoma between 2009 and 2017 were reviewed. After the exclusion of records with unsatisfactory surgical notes and anamnesis, 353 patients were included in the study. The 290 patients who had undergone primary surgery and 63 who had undergone revision surgery were evaluated separately.

結果:

290例中162例（56％）が退縮ポケット型胆汁腺腫であり，290例中128例（44％）が非退縮ポケット型胆汁腺腫であった．I期が80例（28％）、II期が114例（39％）、III期が91例（31％）、VI期が5例（2％）であった。再発率は6.9％（20/290例）であった。これらの患者の2回目の手術時の平均年齢は23.31±10.3歳であった。12人の患者に再発性胆汁腺腫（60％）があり、8人（40％）に残存性胆汁腺腫があった。聴力転帰および手術手技は病期と有意に関連していたが、再発率にはそのような関連性は認められなかった。

RESULTS: Total 162 of 290 (56%) patients had retraction pocket cholesteatoma and 128 of 290 (44%) patients had non-retraction pocket cholesteatoma. Eighty (28%) patients had stage I, 114 (39%) had stage II, 91 (31%) had stage III, and 5 (2%) had stage VI disease. The recurrence rate was 6.9% (20/290). The average age of these patients at the time of the second operation was 23.31±10.3 years. Twelve patients had (60%) recurrent cholesteatoma, and eight (40%) had residual cholesteatoma. Hearing outcome and surgical technique were significantly associated with the disease stage; however, the recurrence rate showed no such association.

結論:

EAONO/JOSステージングシステムは，術後の聴力結果を推定し，手術手技を計画する上で有益であると結論づけた．しかし、再発率とEAONO/JOS病期分類との間には有意な関係はなかった。感染症，小骨嚢，浸潤などの他の要因が再発を予測すると考えられる。EAONO/JOS病期分類システムの普及により、手術成績と予後の評価がより良くなると考えられる。

CONCLUSION: We concluded that the EAONO/JOS staging system is beneficial for estimating the postoperative hearing results and planning the surgical technique. However, there was no significant relationship between the recurrence rate and the EAONO/JOS staging system. We believe that additional factors, such as infection, ossicles, and invasion, predict the recurrence. Widespread use of the EAONO/JOS staging system will enable better evaluation of surgical outcomes and prognosis.