真珠腫症の手術的治療　特に再発について

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  • Surgical treatment of cholesteatoma. A review of the problem of recurrence.
  • シンジュシュショウ ノ シュジュツテキ チリョウ トクニ サイハツ ニ ツイテ
  • -A Review of the Problem of Recurrence-
  • ―特に再発について―

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Since the 1960s the author has utilized intact canal wall tympanoplasty in the treatment of cholesteatoma despite the high incidence of recurrence during the developmental period of the operation, because he has believed that this procedure is the only possible way to control cholesteatoma and preserve the anatomical structures needed for the restoration of hearing and the self-cleansing function of the external ear canal. A follow-up study in 1972 revealed that in 21 of the 56 patients (41%) operated on with this procedure the cholesteatoma recurred within three years. During the 1970s the author attempted to reduce the high rate of recurrence. In 84 patients operated on with staged intact canal wall tympanoplasty during the 1980s there was a recurrence in only 12 (4.4%) three years or more after the operation. These results were due to improvements in surgical technique: removal of the matrix under better surgical view in the first stage operation, and reconstruction of the bony defect in the attic and obliteration of the mastoid cavity in the second stage operation. In spite of improvement in the surgical technique either a residual cholesteatoma or a deep retraction pocket was found during the second stage operation in 30% of the patients. This means that the rate of recurrence was still very high if a second operation was not planned. Until we have a safe and reliable method of detecting microscopic residue of the matrix, the planned staged procedure is indeed needed to reduce the risk of recurrence and to restore good function to the middle and external ear.

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