Maruyama J, Gyo K, Hinohira Y, Nishihara S, Yanagihara N
Department of Otolaryngology, Ehime University, School of Medicine.
Nihon Jibiinkoka Gakkai Kaiho. 1998 Feb;101(2):236-42. doi: 10.3950/jibiinkoka.101.236.
Results of surgery for middle ear cholesteatoma were investigated in 202 ears of 197 patients who had undergone surgery by the staged intact canal wall technique. Surgical procedures used in the second stage for prevention of a retraction pocket were classified into three types: Type S1, no scutumplasty; Type S2, scutumplasty; Type S3, scutumplasty plus mastoid obliteration. Recurrent cholesteatoma was found in 9 ears (4%) and retraction pocket in 47 ears (23%). They occurred between 2 and 120 months (average: 26 months) after the second stage, most frequently at 1 to 3 years. The incidence was higher after Type S3 surgery than after the other types, probably because the middle ear was severely involved in patients who were indicated Type S3 surgery. For prevention of a retraction pocket, bone putty and cartilage were proved to be appropriate materials for scutumplasty, and hydroxyapatite for mastoid obliteration. As the retraction pocket tended to recur in patients with the pocket at the second stage, these patients needed obliteration of the mastoid cavity to prevent a retraction pocket. Postoperative hearing was evaluated according to the criteria proposed by the Japan Society of Clinical Otology. Of 145 ears of the 142 patients who were followed for more than 1 year, 118 ears (81%) the surgery was judged successful. The success rate in hearing was in good accordance with the condition of the tympanic membrane.
对197例采用分期完整外耳道壁技术进行手术的患者的202耳中耳胆脂瘤手术结果进行了调查。第二阶段用于预防内陷袋的手术方法分为三种类型：S1型，不进行上鼓室成形术；S2型，上鼓室成形术；S3型，上鼓室成形术加乳突腔闭塞术。发现9耳（4%）出现复发性胆脂瘤，47耳（23%）出现内陷袋。它们发生在第二阶段后的2至120个月（平均：26个月），最常见于1至3年。S3型手术后的发生率高于其他类型，可能是因为S3型手术适应证的患者中耳受累严重。对于预防内陷袋，骨水泥和软骨被证明是上鼓室成形术的合适材料，羟基磷灰石用于乳突腔闭塞术。由于内陷袋在第二阶段出现内陷袋的患者中容易复发，这些患者需要闭塞乳突腔以预防内陷袋。根据日本临床耳科学会提出的标准对术后听力进行评估。在142例随访超过1年的患者的145耳中，118耳（81%）手术被判定成功。听力成功率与鼓膜状况高度一致。
