人工耳蜗手术中预防面神经损伤的临床研究  

CLINICAL ANALYSIS FOR REDUCTION TO FACIAL PALSY IN COMPLICATIONS OF COCHLEAR IMPLANTATION

作　　者：李广盛[1] 王岚[2] 周艳玲[2] 

机构地区：[1]河北省石家庄市第一医院耳鼻喉科,河北石家庄050011 [2]河北省石家庄市第一医院CT室,河北石家庄050011

出　　处：《河北医科大学学报》2013年第10期1144-1147,共4页Journal of Hebei Medical University

摘　　要：目的通过对人工耳蜗植入手术进行总结,为避免损伤面神经提供临床经验。方法回顾分析35例人工耳蜗植入手术。术前用128排螺旋CT 0.6mm薄层扫描患者颞骨,然后行多平面重组(multi planar reformation,MPR)及曲面重建(curved planar reformation,CPR)重建,模拟经面神经隐窝施行的手术路径,在CT上测量面神经管垂直段与外耳道后壁、面隐窝底与面神经管的距离,并对围手术期情况进行总结。结果术后无面瘫、外耳道后壁及鼓膜损伤发生,共发生术后一过性眩晕6例,头皮血肿3例,发热(>38℃)3例,余无并发症发生。结论人工耳蜗植入术相对安全,但也有面神经损伤等并发症。规范操作标准,针对不同患者进行个性化处理,以保证手术的成功。经面神经隐窝径路的重要解剖学标志在128排螺旋CT扫描时可得到清晰显示,面神经管与周围组织的测量结果对人工耳蜗植入术可提供重要参数,有极佳的临床指导价值。Objective To discuss the perioperative complications of patients with cochlear implantation （CI）,and to supply clinical experience for reduction to facial palsy.Methods A retrospective analysis was made on 35 patients who underwent cochlear implantation.All patients received usual examinations,especially 128-slice spiral CT volume scans.The external,middle and inner ears were stereoscopically reconstructed by using multiplanar reconstruction （MPR） and curved planar reformation （CPR）.In order to simulate the facial recess operation passage,the distance between perpendicular segment of aquaeductus fallopii and posterior wall of meatus acusticus externus and the distance between facial crypt bottom and aquaeductus fallopii were separately measured in CT.Results Perioperative complications：no facial palsy,external auditory canal and membrana tympani injury happened,transient vertigo in 6 cases,scalp hematoma in 3 cases,fever （＞ 38℃）in 3 cases.Conclusion Cochlear implantation/CI is a relatively safe surgical procedure,but risks still persist,especially pay attention to protect facial nerve.To ensure successful operation,perioperative managements should be standardized.128-slice spiral CT scans can clearly show the anatomic details of facial recess passage during artificial cochlear implantation surgery,while the measurements of facial recess anatomy structures can provide important reference data for the operation.

关 键 词：耳蜗植入术 面神经 外科手术 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]