内耳畸形人工耳蜗植入手术难点及其处理  

An analysis of surgical management of difficulties during cochlear implant with inner ear anomalies

作　　者：赖若沙[1] 伍伟景[1] 李葳 谢鼎华[1] 刘嘉[1] LAI Ruosha;WU Weijing;LI Wei;XIE Dinghua;LIU Jia(Department of Otolaryngology,the Second Xiangya Hospital,Central South University,Changsha,410011,China)

机构地区：[1]中南大学湘雅二医院耳鼻咽喉科,长沙410011

出　　处：《临床耳鼻咽喉头颈外科杂志》2020年第10期919-924,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨内耳畸形患儿行人工耳蜗植入手术的难点及其处理方法。方法:186例内耳畸形行人工耳蜗植入术的患儿(内耳畸形组)中,孤立的半规管发育不良6例(3.23%),孤立的大前庭导水管综合征137例(73.66%),Mondini畸形26例(13.98%),不全分隔Ⅲ型6例(3.23%),不全分隔Ⅰ型1例(0.54%),内听道狭窄3例(1.61%),耳蜗发育不良7例(3.76%);随机抽取200例内耳结构正常的人工耳蜗植入患儿为对照组。所收集的资料包括内耳异常的类型、术中表现和临床处理策略以及术后言语康复情况。结果:内耳畸形组中,148例次(77.49%)手术顺利,6例次(3.14%)电极插入不完整,29例次(15.18%)术中出现脑脊液井喷,8例次(4.19%)内耳畸形患儿手术中因为圆窗结构异常而开窗位置定位困难。内耳畸形组术中均采用面隐窝入路,17.8%的患儿存在明显的面神经结构异常,明显多于对照组,仅1例患儿在术后1周出现面神经延迟麻痹,治疗后恢复良好;6.81%的内耳畸形患儿采用扩大圆窗入路进行电极插入,明显少于对照组(28%)。内耳畸形组和对照组行人工耳蜗植入的术后言语康复效果比较差异无统计学意义。结论:内耳畸形患儿行人工耳蜗植入术安全可行且效果显著。内耳畸形患儿发生面神经及圆窗等中耳结构异常的概率更高,因此术前应特别注意阅读影像学结果,以预测术中可能发生的风险。术前制定最安全的手术计划,包括电极的类型和开窗的方式,并且手术必须由经验丰富的外科医生实施或者指导,以根据术中所见调整最优的手术方案。Objective:The purpose of this study is to review the difficulties that can occur during cochlear implant surgery in patients with inner ear abnormalities and the management.Method:A retrospective analysis was made on 186cases of cochlear implant with inner ear malformation,the types of inner ear malformations included 6cases(3.23%)of isolated semicircular dysplasia,137cases(73.66%)of isolated large vestibular aqueducts,26 cases(13.98%)of Mondini malformations,6cases(3.23%)of incomplete septal typeⅢ,3cases(1.61%)of internal auditory stenosis,7cases(3.76%)of cochlear dysplasia and 1case(0.54%)of incomplete septal typeⅠ.Two hundred patients with normal inner ear structures were randomly selected as the control group.The data collected included the types of inner ear abnormalities,intraoperative manifestations,clinical management strategies,and postoperative speech rehabilitation,and the literature was reviewed.Result:148patients(77.49%)with inner ear malformation underwent successful surgery,electrode insertion was incomplete in 6patients(3.14%),and cerebrospinal fluid blowout occurred in 29patients(15.18%),it was difficult to locate the window because of the abnormal structure of the window in 8cases(4.19%).In 191patients,the facial recess approach was adopted intraoperatively,and 17.8%of the patients had significant structural abnormalities of the facial nerve,significantly more than the group with normal inner ear structure.Only 1patient showed delayed facial nerve paralysis 1week after surgery,and recovered well after treatment.6.81%of the patients adopted the expanded round window approach,which was significantly lower than that of the group with normal inner ear structure(28%).There was no significant difference between patients with inner ear malformation and patients with extremely severe deafness with normal inner ear structure who received cochlear implant in speech rehabilitation.Conclusion:Cochlear implant is safe,feasible and effective for patients with inner ear malformation.For patients with inner

关 键 词：耳蜗植入术 内耳畸形 手术难点 手术风险 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]