368例人工耳蜗植入手术分析

An Analysis of 368 Cases of Cochlear Implant Surgery

目的探讨人工耳蜗植入手术的操作程序，以提高手术效率及手术安全性。方法回顾性分析人工耳蜗植入手术368例，手术均采用经后鼓室径路。术中行电极阻抗测试和神经反应遥测，术后拍耳蜗位X线平片判断电极植入情况，术后一个月开机调试及跟踪随访。结果所有患者电极全部顺利植入，人工耳蜗装置工作状态正常。术后3天1例出现迟发型面瘫，用激素保守治疗后逐渐恢复，术后45天1例患儿发生外耳道炎，术后2个月1例出现乳突及耳后骨膜下脓肿，术后7个月1例由于头部外伤致植入体损坏更换植入体，经积极处理后均恢复良好。全部病例术后随访24个月无永久性面瘫、植入体移位及脑膜炎等严重并发症发生，但术后4年3例患儿出现植入体外露合并皮肤感染。结论熟练掌握手术技巧并根据个体特点进行人工耳蜗植入手术对于提高植入成功率、重建听觉、减少手术并发症有着非常重要的意义，术后的长期随访甚至终生随访是必要的。

Objective To investigate the surgical procedures for cochlear implantation in order to improve efficiency and safety of operation. Methods 368 cases of cochlear implantation through posterior tympanotomy approach without intraoperative facial nerve monitoring were studied. The electrode impedance and auditory nerve responses were tested during the operation. X-ray images were taken for all cases to locate the electrodes. The cochlear implants were activated 1 month after the surgery and the follow-up study was conducted afterwards. Results All of the electrodes were inserted successfully and all of the implants worked well. Three days after surgery, one patient had delayed facial paralysis. Forty-five days after surgery, one patient had external otitis in the implanted ear. Two months after surgery, 1 case suffered from mastoid subperiosteal abscesses. Seven months after implantation, the implant was damaged in one case because of a head injury. Their conditions were improved after active treatment. No permanent facial paralysis, meningitis, implant displacement or other serious surgical complications occured during a follow-up period of 24 months, but 3 cases of implant exposure and infection were reported 4 years after implantation. Conclusion Mastery of surgical techniques and individualized surgery can improve the success rate of cochlear implantation, enhance the auditory rehabilitation outcomes and reduce the postoperative complications. Long-term or even lifetime follow-up after surgery is necessary.