术中CT在疑难人工耳蜗植入手术中的应用  

Application of Intraoperative CT in Difficult Cochlear Implantation

作　　者：张德军 高搏[1] 戴朴 ZHANG Dejun;GAO Bo;DAI Pu(Department of Otolaryngology Head and Neck Surgery,PLA General Hospital(Beijing 100000);Department of Otolaryngology,Head and Neck Surgery,Second Hospital of Jilin University(Changchun 130041))

机构地区：[1]解放军总医院耳鼻咽喉头颈外科,北京100000 [2]吉林大学第二医院耳鼻咽喉头颈外科,长春130041

出　　处：《中华耳科学杂志》2018年第6期812-815,共4页Chinese Journal of Otology

基　　金：国家重大科研仪器研制项目;61827805;基于光场计算成像的外科手术三维显微仪器研制;国家自然科学基金重点项目;81730029;基因组拷贝数变异致听觉前庭功能异常的发生机制及干预研究;国家重点研发计划(常见单基因病及基因组病无创产前筛查及诊断技术平研发及规范化应用体系建立)课题;常见单基因病的无创产前诊断技术及配套试剂研发;2016YFC1000704~~

摘　　要：目的通过对术中CT引导下的疑难人工耳蜗植入患者的手术结果观察分析,探讨术中CT在该类手术中的应用价值。方法本研究采用回顾性分析方法,将术中CT引导下行人工耳蜗植入的疑难病例47例(50耳),分为内耳畸形、耳蜗骨化和二次修正手术组,观察记录其术中脑脊液"井喷"、术中调整电极次数及其他并发症情况。结果本研究中内耳畸形42例(44耳),包括共同腔畸形17耳(38.6%)、不完全分隔I型(imcomplete partition type I,IP-I)14耳(31.8%)、不完全分隔II型(imcomplete partition type II,IP-II)4耳(9.1%)和不完全分隔III型(imcom-plete partition type III,IP-III)9耳(20.5%);耳蜗骨化2例(3耳),包括耳蜗骨化Ⅱ级1例2耳、耳蜗骨化Ⅲ级1耳;因植入电极异位行修正手术3例。本研究中所有病例在植入人工耳蜗后即刻行术中CT检查,均证实电极植入到耳蜗内,术中出现脑脊液"井喷"21耳(42.0%),术中需再次调整电极位置7耳(14.0%),所有患者术后均未出现脑脊液漏、脑膜炎及面瘫等严重手术并发症。结论术中CT不仅可以保证电极的精准耳蜗内植入,而且还能帮助术者根据手术中实际情况调整决策,避免了因电极异位需二次手术的风险。术中CT极大地提高了疑难人工耳蜗植入手术的精确性,保证了手术的安全性和可靠性,具有广泛的应用前景。Objective To report utility of intraoperative CT in difficult CI cases and surgical outcomes.Methods This study reviewed 47 difficult CI cases(50 ears)with guidance by intraoperative CT,regarding intraoperative CSF"gusher",number of intraoperative electrode adjustment needed and surgical complications.Results Inner ear malformation was identified in 42 cases(44 ears),including common cavity malformation(17 ears,38.6%),IP-I(14 ears,31.8%),IP-II(4 ears,9.1%)and IP-III(9 ears,20.5%).Cochlear ossification was seen in 2 cases(3 ears)and 3 cases were revision surgeries.Correctly implanted electrodes into the cochlea were confirmed in all cases.Intraoperative CSF“gusher”occurred in 21 ears(42.0%)with no CSF leakage,meningitis,facial paralysis or other serious complications postoperatively.Conclusion Intraoperative CT can not only ensure accurate implantation of electrodes,but also help surgeons adjust surgical plans as required by the actual situation during the operation to minimize the need for revision surgery due to electrode misplacement.Intraoperative CT technology has greatly improved the accuracy of electrode implantation in difficult CI,elevating safety and reliability of the surgery.

关 键 词：耳蜗植入术 内耳畸形 耳蜗骨化 

分 类 号：R764[医药卫生—耳鼻咽喉科]