镫骨手术并发镫井喷3例报告

Stapedial gusher complicated during stapes surgery(with three cases report)

目的报告镫骨手术中并发镫井喷3例及其处理方法。方法回顾性分析镫骨手术中发生镫井喷3例患者的处理经过。首先吸除术野中脑脊液至不再有液体流出,然后取填塞物进行填塞,可用填塞物包括动物胶、骨腊、筋膜、肌肉、静脉瓣等。结果经及时处理,3例患者均止住了脑脊液溢出。术后随访2年,2例未再发生继发性脑膜炎,其中1例眩晕和耳鸣均消失。结论对准备行镫骨手术或内耳开放的患者,术前必须作高分辨CT,确定有无内耳畸形,并仔细询问家族史。

Objective To report 3 cases undergone stapes surgery complicated with stapedial gusher during the operation and to discuss the procedures to treat this condition. Method A retrospective study was carried out among 3 cases undergone stapes surgery and complicated with stapedial gusher during the operation to sum up the clinical experience with its treating process. To treat such a condition, cerebrospinal fluid leaking into the operating field was drained away by sucking till no fluid present in the field any more at first, and then, plugging was done with many kinds of available materials, such as bioglue, bone wax, fascia, muscle, venous flap and so on. Results Following the appropriate treatment, cerebrospinal fluid leaking was successfully stopped during the operating period among all the 3 cases. By the end of following up period lasted for two years after the surgery, the 2 cases with repeatedly occurring otogenous meningitis before the operation were seen without such a condition recurred any more, and the other one case was observed with his vertigo and tinnitus disappeared. Conclusions It is necessary for the patients undergoing stapes surgery or inner ear opening surgery to preoperatively take a HRCT scanning to make sure the possibility with or without inner ear malformations, and supplemented by carefully inquiring about the associated family history.