耳道内径路激光辅助下微创镫骨手术治疗耳硬化症的临床研究  

The treatment of otosclerosis using laser assistedstapedotomy with mini incision in external auditory meatus

作　　者：郝欣平[1] 陈树斌[1] 于子龙[1] 梁凤和[1] 李永新[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科耳鼻咽喉头颈外科教育部重点实验室(首都医科大学),北京100730

出　　处：《临床耳鼻咽喉头颈外科杂志》2016年第5期353-356,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探索耳硬化症患者微创径路进行激光镫骨手术的可行性。方法:以13例(15耳)耳硬化症患者为研究对象,对耳道较宽畅者选择经耳道内微创切口行激光镫骨手术。使用激光切断镫骨肌腱、前后弓,离断砧镫关节,取出镫骨上结构,激光于镫骨底板中央后下部打直径0.6mm的孔,置入相应长度Piston人工听骨。结果:所有患者手术顺利,手术时间约1h。仅1例术后出现眩晕、恶心,予对症治疗后3d眩晕症状明显改善,其余患者均未出现明显不适。术后所有患者耳道内切口愈合良好,耳道通畅,鼓膜完整。患者在术前与术后各个频率气骨导差均差异有统计学意义,气导听力在各频率均有改善,骨导听力在1、2、4kH频率有改善。结论:对于外耳道较宽畅的耳硬化症患者,采用微创切口耳道内径路激光镫骨手术能够有效缩短手术时间,组织损伤小、切口愈合快,并发症少;且耳后或耳前没有切口,便于术后护理,也较为美观。Objective：To investigate the feasibility of the treatment of otosclerosis using laser stapedotomy with mini incision in the external auditory meatus.Method：Thirteen patients（15ears）with otosclerosis evidence on clinic history.They were all operated using the laser assistedstapedotomy by mini incision in external auditory meatus because of the wide straight canal.Laser resection the tendo musculistapedius and anterior and postrior arch,breaking the articulatioincudostapedia,removing the stapes superstructure,making a hole of 6mm diameter in the rear of stapes footplate by laser drilling,implanting the corresponding length Piston artificialossicle.Result：All the surgeries were successful and the operation time was about one hour.There was only one patient manifested vertigo and nausea after the operation.But the symptoms improved three days later after the expectant treatment.All the incisions were healed in the externals.There was significant difference between the preoperative and postoperative PTA.The air conduct improved in every frequent and the bone conduct improved in 1kHz,2kHz and4 kHz.Conclusion：Laser assisted stapedotomy by mini incision in the external auditory meatus in patients having wide straight canal with otosclerosis can shorten the operation time,minimize the tissue damage,fasten the healing of the incision and reduce the complications postoperatively.In addition,the mini incision is beauty and easy to nurse.

关 键 词：微创 激光 耳硬化 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]