锤骨-镫骨底板开窗术治疗先天性中耳畸形17例疗效分析  

Effect of malleostapedotomy procedure on 17 cases of congenital middle ear malformation

作　　者：陈钟壡 谢静[1] 赵鹏飞[2] 龚树生[1] Chen Zhongrui;Xie Jing;Zhao Pengfei;Gong Shusheng(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Radiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院耳鼻咽喉头颈外科,100050 [2]首都医科大学附属北京友谊医院放射科,100050

出　　处：《中华耳鼻咽喉头颈外科杂志》2021年第8期806-811,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的总结行锤骨-镫骨底板开窗术(Malleostapedotomy,MS)的先天性中耳畸形患者的临床特征和术后疗效,探讨MS手术的安全性和有效性。方法回顾性分析2015年1月至2019年12月北京友谊医院17例(18耳)行MS手术的先天性中耳畸形患者的临床资料,其中男10例(11耳),女性7例(7耳),年龄7~48岁。分析总结患者的影像学检查、纯音测听、术中所见以及术后听力改善情况。使用SPSS23.0软件进行统计学分析。结果17例(18耳)患者均表现为患耳自幼听力差。术前颞骨高分辨率CT(HRCT)检查发现9耳有明确畸形(包括6耳砧骨长脚畸形、3耳镫骨前后弓畸形)。术前500、1000、2000、4000 Hz平均骨导听阈为(15.6±10.2)dB HL,平均气导听阈为(60.6±9.7)dB HL,平均气骨导差(45.0±8.9)dB。术中所见18耳均伴有砧骨长脚缺失或发育不全,12耳镫骨底板固定,6耳前庭窗闭锁,全部患者均行Piston假体MS手术。术后随访3个月~1年,平均骨导听阈(14.7±8.8)dB HL,平均气导听阈(37.7±11.6)dB HL,平均气骨导差(23.0±8.0)dB。手术前、后的平均气导阈值和平均气骨导差,差异均具有统计学意义(P值均<0.05),而手术前、后的平均骨导阈值,差异无统计学意义(P=0.550)。结论MS对于砧骨长脚缺失或发育不全、镫骨底板固定或前庭窗闭锁的先天性中耳畸形患者具有安全可靠的手术疗效。术前高分辨力颞骨CT对明显的听骨链畸形及面神经畸形的评估较好,对砧镫关节、镫骨底板固定及前庭窗闭锁的评估不足。合并中耳畸形的人工镫骨手术对术者手术经验和技巧的要求更高,术后听力改善明显,但依然存在一定程度的气骨导差。Objective To conclude the clinical features and the postoperative efficacy of congenital middle ear malformation treated with Malleostapedotomy(MS),and to explore the security and effectiveness of MS surgery.Methods The clinical data of 17 patients(18 ears)with congenital middle ear malformation undergoing MS procedure were analyzed.There were 10 males(11 ears)and 7 females(7 ears),aged from 7 to 48 years.The imaging examination,pure-tone audiometry,intraoperative findings and postoperative hearing improvement of these patients were analyzed and summarized,and software SPSS23.0 was used for statistical analysis.Rusults All the 17 patients(18 ears)presented with hearing loss since childhood on the affected sides.Preoperative high resolution CT(HRCT)of the temporal bone revealed definite malformations in 9 ears(6 ears with incus long process dysplasia and 3 ears with anterior and posterior crus dysplasia).Before surgery,the mean bone conductive hearing threshold at 500,1000,2000 and 4000 Hz was(15.6±10.2)dB HL,the mean air conductive hearing threshold was(60.6±9.7)dB HL,and the mean air-bone gap was(45.0±8.9)dB.During the surgery,all 18 ears were found to be accompanied by absence or hypoplasia of incus long process.12 ears had stapes fixation,6 ears had oval window atresia.All patients were treated with MS procedure by using Piston.The patients were followed up for 3 months to 1 year.The mean bone conductive hearing threshold was(14.7±8.8)dB HL.The mean air conductive hearing threshold was(37.7±11.6)dB HL,and the mean air-bone gap was(23.0±8.0)dB.There were statistically significant differences in the mean air conductive hearing threshold and mean air-bone gap before and after surgery(P<0.05).While there were no statistically significant differences in the mean bone conductive hearing threshold before and after surgery(P=0.550).Conclusions MS procedure is safe and reliable in patients with congenital middle ear malformation of incus long process dysplasia,stapes fixation or oval window atresia.HRCT is useful

关 键 词：先天性中耳畸形 耳外科手术 锤骨-镫骨底板开窗术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]