单纯性中耳畸形术前虚拟CT耳镜评估及手术进路选择  

Preoperative Virtual CT Endoscopy for Evaluation of Congenital Middle Ear Malformations and Selection of Surgical Approach

作　　者：蒋立新[1] 肖志文[1] 涂博[1] 马玉坤[1] 龙镇[1] 廖志芳[1] 

机构地区：[1]暨南大学附属第一医院耳鼻咽喉头颈外科,广州510630

出　　处：《中华耳科学杂志》2013年第1期76-79,共4页Chinese Journal of Otology

基　　金：广东省医学科学基金资助项目(A2007335)

摘　　要：目的探讨虚拟CT耳镜对单纯性中耳畸形的术前评估并依其分型选择合适的手术进路.方法对21例（23耳）单纯性中耳畸形患者行颞骨CT三维重建技术—虚拟CT耳镜观察,依听骨链畸形程度将中耳畸形分为三型.A型（上半部畸形）和C型（全听骨链畸形）经耳后切口行保留完整外耳道后壁的上鼓室进路鼓室探查术;B型（下半部畸形）经耳道内进路行传统的鼓室探查术.结果21例（23耳）中耳畸形,虚拟CT耳镜发现9耳为A型,5耳C型,经完壁式上鼓室进路行听骨链松解术或听骨链成形术;9耳为B型,经耳道内进路完成前庭窗开窗与人工镫骨手术.23耳术后外耳道和鼓膜均保存或恢复完好,语频听力平均提高15~35 dB.手术探查听骨链畸形与术前虚拟CT耳镜观察基本符合.结论虚拟CT耳镜能为单纯性中耳畸形听骨链病变提供清晰的三维立体图像,有助于选择手术进路.Objective To investigate the value of preoperative virtual CT endoscopy in evaluation of congenital mid？dle ear malformations and selection of surgical approach. Methods High resolution CT scanning was conducted in 21 pa？tients （23ears） with congenital middle ear malformations to collect original image data focused on the middle ear, followed by 3-dimensional reconstruction to evaluate ossicular chain disorders. Middle ear malformations were classified into three types based on the degree of ossicular deformity. A retroauricular attic approach with ear canal wall preservation was select？ed for types A and C malformations, and traditional exploratory tympanotomy via an ear canal incision was selected for type B malformations. Results Virtual CT endoscopy showed type A malformations in 9 ears, type C malformations in 5 ears, and type B malformations in 9 ears were, which were treated with vestibular window fenestration and artificial stapes prostheses. Reconstructed external auditory canal and tympanic membrane remained intact postoperatively in 23 ears, with an average of 15 to 35 dB speech frequency hearing improvement. Preoperative Virtual CT endoscopy results were basically consistent with surgical exploration findings.Conclusions Virtual CT endoscopy provides important reference data for preoperative evaluation in congenital middle ear malformations. Selection of surgical approach can be based upon the type of congenital middle ear malformations revealed by virtual CT endoscopy.

关 键 词：耳 听小骨 畸形 体层摄影 X线计算机 虚拟CT耳镜 

分 类 号：R764.2[医药卫生—耳鼻咽喉科] R764.72[医药卫生—临床医学]