人工耳蜗植入术后CT影像学评估的临床价值及进展  

Clinical values and advances in computed tomography evaluation after cochlear implantation

作　　者：顾文汐 贾欢[1,2,3] 吴皓 GU Wenxi;JIA Huan;WU Hao(Department of Otolaryngology-Head and Neck Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases,Shanghai 200125,China;Ear Institute,Shanghai Jiao Tong University School of Medicine,Shanghai 200125,China)

机构地区：[1]上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科,上海200011 [2]上海市耳鼻疾病转化医学重点实验室,上海200125 [3]上海交通大学医学院耳科学研究所,上海200125

出　　处：《上海交通大学学报（医学版）》2023年第12期1463-1469,共7页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市耳鼻疾病转化医学重点实验室(14DZ2260300);上海交通大学医学院转化医学协同创新项目(TM202011);上海交通大学医疗机器人研究院项目(IMR-NPH202001);上海市临床重点专科建设项目(shslczdzk00802);上海申康医院发展中心临床创新三年行动计划(SHDC2020CR1044B)。

摘　　要：人工耳蜗植入术是治疗重度及极重度感音神经性聋的儿童和成人患者的主要手段。电极在耳蜗内的位置是影响术后听力言语康复效果的重要因素之一,术后残余听力的保存与电极植入过程中对内耳结构的损伤程度密切相关,适当的植入深度和理想的电极位置对于良好的频率识别至关重要。植入后的影像学检查包括X线片和计算机断层扫描术(computed tomography,CT)。相比X线片,CT具有三维成像的优势。通过植入术后的CT影像学检查和评估,能够明确电极的完整程度,有助于确保手术的安全性和辅助术后调机或故障分析。基于CT影像学的三维重建方法让电极位置的评估更加直观和准确,有助于判断植入过程对于内耳精细结构损伤的程度,分析对听觉、言语预后的影响。人工耳蜗植入后的CT影像学评估在推动电极设计、改进柔手术技巧、推广机器人或手术导航等新手段的应用等方面功不可没,越来越受到有关研究者的关注。该文就人工耳蜗植入术后CT影像学评估的临床应用价值和技术进展等进行述评。Cochlear implantation has been a standard rehabilitation for children and adult patients with severe to profound sensorineural deafness.The intracochlear localization of the electrode array is one of the key factors related to the postoperative auditory and speech outcomes.Preservation of the residual hearing is related to the trauma to the inner ear structures caused in the insertion process.Optimal insertion depth and positioning of the electrode array is important for frequency discrimination.The postoperative position of the electrode array is evaluated by using plain X ray or computed tomography(CT).Compared to the plain X ray,CT produces three-dimensional(3D)imaging.With the application of post-operative CT evaluation,the integrity of the electrode array can be verified for surgical safety and improving programming accuracy.Different 3D reconstruction techniques and methods based on the post-operative CT imaging have been proposed to facilitate the precise recognition of position of each electrode,thus helpful to evaluate the possible insertion trauma to inner ear structures and the potential effect on auditory and speech outcomes.The post-operative CT evaluation has helped the electrode array design,brought progress to the soft surgery procedure and promoted new technologies such as robotic surgery and navigation.Therefore,it is getting more and more attention.This article reviews the clinical application values and the progress of techniques in post-operative CT evaluation of cochlear implantation.

关 键 词：人工耳蜗植入术 计算机断层扫描术 多平面重建 三维融合重建 

分 类 号：R764.35[医药卫生—耳鼻咽喉科]