经耳道全耳内镜技术在儿童中、内耳手术中的应用  

The application of total endoscopic ear surgery in middle ear and inner ear diseases in children

作　　者：刘薇[1] 陈敏[1] 马宁[1] 张晓 杨扬[1] 邵剑波 王晓旭 甄俊淞 刘珊珊 张圣楠 郭丽宁 张杰[1] LIU Wei;CHEN Min;MA Ning;ZHANG Xiao;YANG Yang;SHAO Jianbo;WANG Xiaoxu;ZHEN Junsong;LIU Shanshan;ZHANG Shengnan;GUO Lining;ZHANG Jie(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,儿童耳鼻咽喉头颈外科疾病北京市重点实验室,北京100045

出　　处：《中国眼耳鼻喉科杂志》2023年第3期243-247,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：北京市医院管理中心儿科学科协同发展中心专项经费资助(XTYB201828);北京市医院管理中心“登峰”计划专项经费资助(DFL20191201)。

摘　　要：目的探讨耳内镜技术用于儿童中耳、内耳手术的适应证、术前评估及术中要点。方法收集2016年1月~2021年1月于北京儿童医院耳鼻咽喉头颈外科行经耳道全耳内镜手术患儿的临床资料,记录其年龄、病种、术前颞骨CT所见、听力、术中所见及术后随访情况,归纳术前评估要点,总结诊疗路径。结果①共收集经耳道全耳内镜手术123例(123耳),其中鼓室成形术70例(70耳),中耳胆脂瘤切除术30例(30耳),脑脊液耳漏修补术23例(23耳)。②年龄最小1岁1个月,最大17岁,鼓室成形术的中位年龄为8岁5个月,中耳胆脂瘤切除伴听骨链重建术的中位年龄为4岁3个月,脑脊液耳漏修补术的中位年龄为4岁2个月。③颞骨CT测量耳道宽度:鼓室成形术患儿外耳道横径5.0~7.15 mm,纵径4.5~6.5 mm;中耳胆脂瘤切除术患儿外耳道横径4.6~6.0 mm,纵径4.5~6.5 mm;脑脊液耳漏修补术外耳道横径4.5~6.0 mm,纵径4.5~6.5 mm。④中耳胆脂瘤患儿病变范围:局限于中鼓室5例、局限于上鼓室5例;病变位于中鼓室及上鼓室10例;合并侵犯咽鼓管上隐窝和(或)鼓室窦10例。其中6例合并鼓室窦病变患儿术中联合应用0°及70°内镜。⑤脑脊液耳漏修补术漏口均位于前庭窗,取出镫骨后可见底板不同程度骨质缺损。⑥鼓室成形分型:Ⅰ型66例,Ⅱ型1例,Ⅲ型3例。⑦转归:鼓室成形和中耳胆脂瘤切除术后患儿听力均有不同程度提高(P<0.001);2例(2/66)Ⅰ型鼓室成形术患儿术后半年存在鼓膜小穿孔,余患者鼓膜愈合良好;胆脂瘤随访至今无复发病例;脑脊液耳漏术后2例因再次出现耳溢液,行耳内镜下二次封堵术,后随访至今无复发。结论儿童经耳道全耳内镜可适用于中、内耳手术,并获得良好预后;术前针对耳道宽度、病变范围、漏点定位等评估,是顺利完成耳内镜手术的保障。Objective A retrospective analysis of pediatric cases of total endoscopic ear surgery(EES)through the auditory canal was made to explore the indications,preoperative evaluation,and key points of intraoperative application of EES in children’s middle and inner ear surgery.Our purpose was to promote the application of the visualized and minimally invasive technology in children’s middle and inner ear surgery.Methods A retrospective analysis of the patients with EES from Beijing Children’s Hospital from January 2016 to January 2021 was made.The patients’age,disease name,preoperative temporal bone CT findings,hearing,intraoperative findings,and postoperative follow-up were included.The key points of preoperative evaluation and the clinic paths were summarized.Results A total of 123 cases(123 ears)of EES were collected,including 70 cases(70 ears)of tympanoplasty,30 cases(30 ears)of middle ear cholesteatoma resection,and 23 cases(23 ears)of cerebrospinal fluid otorrhea repair.The minimum age was 1 year and 1 month,and the maximum age was 17 years.The median age for tympanoplasty was 8 years and 5 months.The median age for middle ear cholesteatoma resection with ossicular chain reconstruction was 4 years and 3 months,and the median age for cerebrospinal fluid(CSF)otorrhea repair was 4 years and 2 months.The transverse diameter of the external ear canal(EAC)in children undergoing tympanoplasty was 5.0~7.15 mm,and the longitudinal diameter was 4.5~6.5 mm.The transverse diameter of the EAC in children undergoing middle ear cholesteatoma resection was 4.6~6.0 mm,and the longitudinal diameter was 4.5~6.5 mm.The transverse diameter of the EAC in patients with CSF otorrhea was 4.5~6.0mm,and the longitudinal diameter was 4.5~6.5 mm.Children with middle ear cholesteatoma had lesions limited to the middle tympanic cavity.Five cases had lesions limited to the upper tympanic cavity.Ten cases of lesions located in both the middle and upper tympanic cavities.Ten cases involved the superior recess of the eustachian tube and/or

关 键 词：耳内镜手术 中耳胆脂瘤 脑脊液耳漏 鼓室成形术 儿童 

分 类 号：R764[医药卫生—耳鼻咽喉科]