振动声桥置入与耳廓再造同期手术治疗先天性外中耳畸形  

Simultaneous operations of vibrant soundbridge implantation and auricular reconstruction for patients with microtia and atresia

作　　者：赵春丽[1] 赵守琴[1] 章庆国 李洁[1] 王丹妮[1] 任冉[1] 陈沛维 Zhao Chunli;Zhao Shouqin;Zhang Qingguo;Li Jie;Wang Danni;Ren Ran;Chen Peiwei(Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing 100730, China;Department Four of Plastic Surgerv, Chinese Academy of Medical Sciences , Beijing 100144, China)

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,首都医科大学耳鼻咽喉头颈科学教育部重点实验室,100730 [2]中国医学科学院北京协和医学院整形外科医院整形四科,100144

出　　处：《中华整形外科杂志》2019年第3期248-253,共6页Chinese Journal of Plastic Surgery

基　　金：北京市科委首都临床特色应用研究基金(Z171100001017079).

摘　　要：目的探讨先天性外中耳畸形患者振动声桥(vibrantsoundbridge,VSB)置入与耳廓再造同期手术的安全性及可行性。方法回顾性分析2014年8月至2017年7月于北京同仁医院耳外科行VSB置入与耳廓再造同期手术的6例先天性外中耳畸形患者的临床资料,其中男5例,女1例,年龄7~12岁,VSB置入前0.5、1、2、4kHz平均气导阈值为64.8dBHL。用皮肤扩张法行耳廓再造时,VSB置入在耳廓再造的第三期时完成;采用非皮肤扩张法耳廓再造时,VSB置入在耳廓再造的第二期同时进行。评估术后半年耳廓形态满意度、手术并发症、听力改善程度及言语识别率。结果所有患者和家属对耳廓形态表示满意;均未发生耳廓变形、软骨支架外露、感染、血肿、皮瓣坏死、面瘫、耳鸣、眩晕等并发症。VSB置入后声场测试,听阈平均值为36.7dBHL,降低了28.1dBHL。在65dBSPL、80dBSPL声场下,安静状态和噪音状态时言语识别率均有提高。结论耳廓再造与VSB置入同期手术是安全可行的,不仅可以达到良好的治疗效果,而且可减少手术次数、减轻社会经济负担。Objective To discuss the safety and efficacy of simultaneous procedures of vibrant soundbridge implantation and auricular reconstruction with congenital external and middle ear malformation. Methods This is a retrospective study, including 6 patients, 5 boys and 1 girl, aged 7-12 years. All patients received simultaneous operations of vibrant soundbridge implantation and auricular reconstruction. The mean preoperative air conduction threshold was 64.8 dB HL at 0.5, 1, 2, and 4 kHz. The VSB was placed in the third stage of auricle reconstruction, if the soft tissue expansion was performed;otherwise, the VSB was implanted in the second stage. The satisfaction with reconstructed auricle, surgical complications, hearing improvement and speech discrimination scores were evaluated 6 months after surgery. Results All patients and their families reported satisfaction with their reconstructed auricle. There was no complications, including cartilage framework exposion, infection, hematoma, skin flap necrosis, facial paralysis, tinnitus, vertigo or others. Post-operatively, mean VSB-aided hearing threshold was 36.7 dB HL, which was reduced by 28.1 dB HL. The mean speech discrimination scores measured in a sound field with a presentation level of 65 dB SPL and 80 dB SPL were improved. Conclusions The simultaneous operations of auricle reconstruction and Vibrant Soundbridge implantation is an alternative method for patients with congenital microtia and atresia.

关 键 词：听觉丧失 传导性 中耳置入 先天性耳畸形 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]