1448例人工耳蜗植入手术中疑难问题的总结

Surgery difficulties of 1448 cochlear implantation cases

目的通过对1448例人工耳蜗植入手术的总结,讨论人工耳蜗植入术中疑难问题,为提高人工耳蜗植入手术的成功率提供参考。方法1448例人工耳蜗植入手术病例资料来源于1998年1月～2009年3月。术前信息年龄8.5个月～51.2岁,平均年龄为4.5岁。全部为双耳重度和极重度感音神经性聋,其中语前聋患者1430例、成人语后聋患者18例。术前进行常规检查包括:①听力学检查、影像学检查、小儿肢体智力发育评估。②全麻常规检查。手术方法:①按常规面神经隐窝入路自耳蜗底转鼓阶植入耳蜗电极。②自乳突入路从耳蜗与前庭共同腔后下植入耳蜗电极。③在开放式乳突腔内埋藏电极线后仍于圆窗入路植入耳蜗电极。手术疑难判断方法:①无法按常规面隐窝入路手术者。②由于乙状窦、天盖、外耳道壁等解剖问题不能顺利完成乳突轮廓化者。③由于面神经、鼓索神经、外耳道骨壁的解剖问题使开放面隐窝的空间狭小导致暴露圆窗困难者。④耳蜗或圆窗等骨化或畸形等问题不能按常规自圆窗口部顺利植入耳蜗电极者。结果①手术成功率:1448例人工耳蜗植入手术均一期成功,成功率为100%。②术中疑难问题:术中疑难问题共241例(耳),占16.64%,其中非常规手术入路10例,乙状窦前移影响手术入路4例,面神经垂直部高位并前移使与鼓索神经或外耳道壁的距离狭小影响圆窗的暴露179例,耳蜗底转骨化影响打开耳蜗鼓阶23例,圆窗骨化无法以圆窗为标记打开耳蜗鼓阶15例,耳蜗海绵状改变判断鼓阶正确位置困难5例,耳蜗与内听道共同腔耳蜗电极在共同腔内正确摆放困难5例。结论对1448例人工耳蜗植入手术总结体会认为,人工耳蜗植入手术中的疑难问题主要表现为:①面神经垂直部过度前移影响圆窗的暴露。②耳蜗骨化或海绵状改变影响开放耳蜗鼓阶。

Objective To review our experiences of 1448 cases of cochlear implantation with an emphasis on the difficulty surgery. Methods A retrospective analysis of 1448 cases who underwent cochlear implantation from February 1998 to March 2009. All the patients with severe to profound sensorineural hearing loss ages ranged from 8.5 months to 51.2 years with an average age of 4.5 years. 1430 cases were pre-lingual deaf, 18 cases were post-lingual adult deaf patients. Routine pre-operation tests include hearing tests, HRCT and MRI scan and intelligence-psychology evaluation. There approaches were used for the electrode insertion： through the facial recess, through the postinferior edge of the common cavity and the mastoid cavity in the cases after mastoidectomy. The follow situations were categorized into difficulty surgery： the electrode failed to insert through facial recess, difficulty mastoid skeletation due to abnormalities of the sigmoid sinus ,tegmen and the external canal wall ;narrow facial recess due to the abnormalities of facial nerve, chorda tympani nerve and the external canal wall;the electrode falied to insert due to cochlear ossification and round window abnormalities. Results All the electrode were inserted successfully.one stage in all the 1448 cases.241（16.64%） difficulty surgeries including： 10 cases surgeries were performed by abnormal approaches：sigmoid sinus antedisplacement 4 cases, 179 cases have some difficulties in the exposure of round window due to the anterior positioned facial nerve, cochlear basal turn ossification 23 cases, round window ossification 12 cases, cochlear otospongiosis 5 cases, 5 cases have some difficulties in the placement of the electrode due to the common cavity. Conclusions The most surgery difficulties in cochlear implantation including the anterior positioned facial nerve may impact the exposure of the round window; the cochlear ossification may impact the open of the scala tympani.