先天性镫骨畸形的外科治疗  

The surgical management of congenital stapes malformation

作　　者：杨仕明[1] 刘清明[2] 黄德亮[1] 韩东一[1] 杨伟炎[1] 

机构地区：[1]解放军总医院耳鼻咽喉-头颈外科,解放军耳鼻咽喉科研究所,北京100853 [2]广东省珠海市妇幼保健院儿保科听力筛查中心,珠海519000

出　　处：《中华耳科学杂志》2005年第3期173-176,共4页Chinese Journal of Otology

摘　　要：目的探讨先天性中耳畸形镫骨手术治疗的远期疗效以及影响疗效的相关因素。方法对解放军总医院耳鼻喉科1984年4月-2002年3月先天性中耳畸形接受镫骨手术58例患者进行随访,对随访半年以上、资料完整的51例(70耳)进行回顾性总结,应用Stata7.0统计软件进行远期疗效分析。语言频率(0.5、1、2kHz)气导听力提高15dB以上为手术成功标准。结果本组患者术前气导最小30dB,最大75dB,平均58.6±6.9dB,听力损失主要为低频为主,多呈上升曲线。半年后复诊气导最小20dB,最大65dB,平均21.6±13.1dB。半年、1年、2年、5年以上手术成功率分别为91.4%(64/70)、93.5%(43/46)、93.5%(29/31)、91.8%(11/12)。手术方式的选择上,镫骨钻孔活塞术(Teflon小柱)、镫骨切除术(自体或异体骨柱)、镫骨撼动术半年后成功率为92.3%(36/39)、81.3%(13/16)、80.0%(12/15)。远期疗效主要影响因素(按影响力大小)依次为:镫骨足板病变、手术并发症、砧镫关节畸形、患者年龄。结论镫骨手术是治疗先天性镫骨畸形有效的手术方法,其远期听力效果比较稳定。与镫骨切除术和撼动术相比较,镫骨钻孔活塞术后听力增进较好。Objective To study the long-term curative effect of stapedioplasty on congenital stapes malformation and its influent factors. Methods Retrospectively sum up the curative effect of stapedioplasty on congenital stapes malformation in 51 patients （70 ears） in our hospital from 1984 to 2002. Results The air conduction pre-operation was ranged from 30dB to 75dB, with the average of 58.6±6.9 dB, and the loss of audition was mostly low frequency. Following-up the half-year postoperation the air conduction was ranged from 20dB to 65dB, with the average of 21.6±13.1dB. The total successful rate of operation was 91.4%, and still maintained in stable hearing level. Comparing the different operative methods, stapedotomy （piston technique） own the best effect on recovery of hearing, then was stapedectomy, and the last one was stapediolysis. The influent factors to successful rate were pathological changes of stapes, operative method, complication during operation and age. Conclusion Stapedial surgery is the effective method to treat congenital stapes malformation.

关 键 词：先天性畸形 镫骨 外科手术 远期疗效 先天性镫骨畸形 外科治疗 先天性中耳畸形 远期疗效分析 手术成功率 镫骨切除术 

分 类 号：R764.7[医药卫生—耳鼻咽喉科] R739.650.5[医药卫生—临床医学]