口蓋裂児の鼓膜切開チューブ長期留置における「自然脱出まで待つ」戦略の成績．

Outcome of the 'waiting until spontaneous extrusion' strategy for long-term tympanostomy tube placement in children with cleft palate.

抄録

背景:

口蓋裂児の滲出性中耳炎（OME）は治療抵抗性であることが知られており、これらの患者のほとんどは換気チューブ（VT）留置のために手術を受ける。

BACKGROUND: Otitis media with effusion (OME) in children with cleft palate (CP) is known to be refractory to treatment and most of these patients undergo surgery for ventilation tube (VT) placement.

目的:

自然流出まで待つ」戦略で長期VTを使用したCP小児の転帰を明らかにすること。

OBJECTIVES: To identify the outcomes of children with CP using long-term VT with a 'waiting until spontaneous extrusion' strategy.

材料および方法:

2016年12月から2017年11月に当科を受診し、当科で長期VT留置を受けたCPの全児童のカルテをレトロスペクティブに検討した。残留穿孔およびOMEの再発に関連するリスク因子を分析した。

MATERIAL AND METHODS: We retrospectively reviewed the medical records of all children with CP who visited our department from December 2016 to November 2017 and who received long-term VT placement in our department. Risk factors related to residual perforation and recurrence of OME were analyzed.

RESULTS:

合計106名の小児が本研究に含まれた。VT喪失後3ヶ月以上追跡した94耳の統計解析の結果、VT留置期間の長さは残存穿孔と関連し、VT留置期間の短さはOME再発と関連することが明らかになった。VT の留置期間が長いほど率は高くなるが、予想通り、超長期の VT の留置は残存穿孔と関連はなかった。VTの半数は、挿入後40ヶ月目に自然排出された。

RESULTS: A total of 106 children were included in this study. Our statistical analysis of 94 ears followed for more than three months after VT loss revealed that longer VT placement was associated with residual perforation, and shorter VT placement was associated with OME recurrence. Although a longer duration of VT placement was associated with an increased rate, extremely long-term VT placement was not associated with residual perforation, as expected. Half of the VTs were spontaneously extruded at 40 months after insertion.

結論と意義:

自然脱出を待つという戦略を用いた長期のVT挿入は、CP患児にとって潜在的な選択肢である。

CONCLUSIONS AND SIGNIFICANCE: Long-term VT insertion using a waiting until spontaneous extrusion strategy is a potential option for children with CP.