CO2激光辅助MVP技术治疗先天性听骨链畸形结果分析

Outcomes of Treatment of Congenital Auditory Ossicle Deformity with CO2 Laser Assisted MVP Technique

目的应用CO2激光辅助Malleovestibulopexy(MVP)技术治疗先天性听骨链畸形并观察其疗效。方法10例(14耳)先天性听骨链畸形患者,其中6例为单侧传导性聋,4例为双侧传导性聋。14耳均行CO2激光辅助下MVP技术重建听力。通过术前、术后气骨导差比较疗效。手术关键:(1)术中保留锤骨柄完整;(2)以CO2激光行镫骨底板或卵圆窗开窗,直径约为0.6mm;(3)人工听骨置入小窗,并固定于锤骨柄靠近锤骨颈处。结果 14耳先天性听骨链畸形患者中,13例均为镫骨底板固定,1例为前庭窗封闭;其中6耳为砧骨长脚缺失,镫骨上部结构缺失;1耳为砧骨豆状突缺失、镫骨上部结构缺失;1耳为听骨链完整、连接,锤砧关节不活动,砧骨、固定;1耳为听骨链完整、连接,锤砧关节活动,砧骨长脚倾斜度增大;1耳为砧骨缺如,镫骨上结构缺失;2耳为砧骨后倾,长脚压于面神经表面,镫骨上部结构缺失1耳为砧骨长脚缺失,砧骨与镫骨间膜性连接,镫骨上结构存在,镫骨底板固定;还有1耳为砧骨长脚缺失、镫骨上结构畸形伴先天性鼓室胆脂瘤,镫骨底板固定。术前言语频率平均气骨导差为46.5dB,术后言语频率气骨导差平均值为9.71dB,较术前缩小36.79dB(P<0.01);术后患者无恶心、呕吐及明显眩晕。结论镫骨底板固定或封闭伴砧骨缺如或病变的先天性听骨链畸形,采用CO2激光辅助MVP技术可以提高听力,其疗效显著、安全系数高、术后反应轻微。

Objective To evaluate the efficacy of CO2 laser-assisted malleovestibulopexy(MVP) in the treatment of congenital ossicular chain abnormalities. Methods Ten patients(14 ears) with congenital ossicular chain abnormalities causing unilateral(n=6) or bilateral(n=4) conductive deafness underwent CO2 laser-assisted MVP implantation.Pre-and postoperative air conduction hearing thresholds were compared to evaluate treatment efficacy. Key surgical elements: 1) preservation of the integrity of malleus;2) CO2 laser fenestration of stapes footplate or oval window(diameter = 0.6 mm);and 3) MVP into the fenestration and secured to the malleus. Results Of the 14 ears, congenital ossicular chain deformity included stapes footplate fixation(n=13), closed vestibular window(n=1), missing incus long process and stapes suprastructure(n=6), missing incus lenticular process and stapes suprastructure(n=1), fixed malleoincudal joint and incus but otherwise intact ossicular chai(n=1), abnormally increased incus long process tilt but otherwise intact and mobile ossicular chain(n=1), missing incus and stapes suprastructure(n=1), backward tilting incus with long process on facial nerve and missing stapes suprastructure(n=2), missing incus long process with membranous connection between incus and fixed stapes(n=1), and missing incus long process with fixed and deformed stapes suprastructure and cholesteatoma(n=1). Mean speech frequency thresholds was 46.5 dB HL preoperatively and 9.71 d B HL postoperative, improved by 36.79 dB(P <0.01). There was no nausea, vomiting or obvious dizziness postoperatively. Conclusions For congenital ossicular chain deformities involving stapes footplate fixation or closed oval window with missing or deformed incus,CO2 laser assisted MVP can significantly improve hearing, and it is safe with minimal postoperative reactions.