- 期刊
耳前瘻管切除後復發之探討
Recurrence of Preauricular Fistulae after Excision
摘要
背景;耳前廔管切除是住院醫師經常施行的手術之ㄧ，但是臨床常有復發的報告，主要是因為病灶未能完全切除，傷口內仍殘留有上皮組織所造成。本研究院希望藉由收集接受耳前廔管切除病人的資料，分析依些可能會影響到手術後復發的因素，以提供未來手術之參考。 方法;自1997年1月至1998年12月3年期間，在本月接受耳前廔管切除術且資料完整者共有97名病患，合計124耳。手術後追蹤時間皆在6個月以上。同一病人雙耳均接受手術時，視為二次獨立的手術。本研究院所使用的統計方法為Chi-Square test。 結果;手術後傷口有發炎感染的情形，或者是傷口癒合不良並有持續滲出液，我們定義為復發。本研究總計124耳(97名患者)，其中有12耳復發，整體復發率為9.7%。以施行手術來比較，由住院醫師(第3年住院醫師或總醫師)在主治醫師的指導之下施行者復發率為10.8%，由主治醫師親自施行者復發率為6.5%。由住院醫師所施行的耳前廔管切除術，雖然復發率較高┬案在統計學上並沒有明顯差異。就麻醉方式而言，採取局部麻醉者有74耳，其中8耳復發；全身麻醉者有50耳，其中有4耳復發，沒有統計學上的差異。採取門診手術者有62耳，期中有7耳復發；採取有住院手術者有62耳，其中有5耳復發，也沒有統計學上的差異。 結論；住院醫師所施行的耳前廔管切除術，復發率較高，雖然與主治醫師所施行者沒有統計學上的意義，但是對於住院醫師來說，手術時一定要確認耳前廔管的範圍及周圍耳棆軟骨，顯肌膜等之相關位置，完全切除病灶，避免復發。(中耳醫誌 2000; 35;225-229)
關鍵字
耳前廔管並列摘要
BACKGROUND Excisions of preauricular fistulae are routinely performaed by otolary-gologists. Sometimes, fistulae with extensive and deep branching ramification may recurrence. This study attempted to identify the factors influencing the results of prauricular fistula excision. MeETHOD;this study was a retrospective evaluation of the reports 97 patients(124 operations) treated between January 1997 and December 1998 in our department, Bilat-eral excisions were regarded as two operations. The postoperative follow-up was more than six months for each patient. RESULTS;The overall recurren rate in this study was 9.68%(twelve of the 124 fistulae).Ninety-three oprations were performed by residents with 10 fistulae(10.8%)recurring. The other 31 operations were performed by attenging physicians with two fistulae(6.5%) recurring. The recurrence rate was higher for the residents, but the difference was not statistically significant(p＞0.1).There was high recurrence rate(25%) after revision of excised fistulay. Seventy-four operations were compieted under local anesthesia with eight fistulae recurring, whereas the other 50 operations were performed under general anesthesia with four fistulae recurring. Complete removal of the fistula trace is the main- stay preventing recurrence. Careful identification of the fistula tract and its surround-ing helical cartilage and temporal fascia may help to decrease the recurrence rate CONCLUSION; Complete removal of sinus tract is the mainstay of prcauricular fistulcc- tome. THE recurrence rate of fistulectomy performed by residents is higher then attending physicians, even no statistical significance. Residents should pay more attention than attending physicians on identifying the field of sinus tract and its relationship to the surrounding helical cartilage and temporal fascia