Department of Otorhinolaryngology, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo 113-8519, Japan.
Department of Plastic Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo 113-8519, Japan.
Auris Nasus Larynx. 2021 Dec;48(6):1157-1161. doi: 10.1016/j.anl.2021.02.003. Epub 2021 Feb 25.
To evaluate the surgical procedures used to treat external auditory canal cancer with respect to avoiding postoperative infection of the temporal bone defect.
Enrolled in the study were 52 patients with external auditory canal cancer surgically treated between July 2015 and October 2020 (38 lateral temporal bone resections, 12 subtotal temporal bone resections and 2 partial resections, accompanied by various combined procedures). Retrospective chart review was conducted taking into consideration postoperative infection, and univariate analysis of prognostic factors was performed.
In cases managed with subtotal temporal bone resection, no postoperative infections occurred. Cases managed with subtotal temporal bone resection demonstrated increased use of free-flap reconstruction, and longer antibiotic infusion period. On the other hand, analysis of cases managed with lateral temporal bone resection revealed 10 out of 38 patients with postoperative infection (26.3%). However, we couldn't find out any factors that contributed significantly to the prevention of postoperative infection, including the surgical procedures used to manage the defected space, which included free-flap implantation, obliteration with fat tissue, muscular flap rotation, and leaving the space empty without obliteration or reconstruction.
In cases managed with lateral temporal bone resection, leaving the resected space empty did not increase the risk of infection. On the other hand, in cases with subtotal temporal bone resection, filling the surgical defect with an autologous bulk, including the free-flap reconstruction and fat obliteration, seems to prevent the infection. Moreover, prolonged antibiotic infusion may suppress postoperative infection of the temporal bone defect.
评估避免颞骨缺损术后感染的外耳道癌手术方法。
回顾性分析 2015 年 7 月至 2020 年 10 月收治的 52 例外耳道癌患者（38 例外侧颞骨切除术、12 例次全颞骨切除术和 2 例部分切除术，同时进行各种联合手术）的临床资料。考虑术后感染，对预后因素进行单因素分析。
次全颞骨切除术后无感染。次全颞骨切除术患者游离皮瓣重建比例增加，抗生素输注时间延长。然而，分析外侧颞骨切除术患者发现，38 例中有 10 例（26.3%）术后感染。但我们未能发现任何有助于预防术后感染的因素，包括处理缺损空间的手术方法，包括游离皮瓣植入、脂肪组织填塞、肌瓣旋转以及不填塞或重建而使空间空置。
外侧颞骨切除术后，使切除空间空置不会增加感染风险。另一方面，在次全颞骨切除术中，用自体大块组织填充手术缺损，包括游离皮瓣重建和脂肪填塞，似乎可以预防感染。此外，延长抗生素输注时间可能会抑制颞骨缺损的术后感染。
