虚拟CT耳镜评价先天性单纯性中耳畸形的临床应用

Evaluation on the virtual CT endoscopy of the simple congenital malformation and its clinical application

目的：探讨虚拟CT耳镜评价先天性中耳畸形中听骨链病变的临床应用。方法：对13例（16耳）先天性中耳畸形患者行高分辨率CT扫描，将获取的原始图像数据经三维重建后，以虚拟CT耳镜的方式从不同角度与方向观察听骨链的病变情况，并依观察结果进行术前评估，将术前虚拟CT耳镜观察结果与手术探查结果对比分析。结果：13例（16耳）中耳畸形，虚拟CT耳镜发现5耳锤骨及砧骨上部结构发育不良或固定在上鼓室内壁，镫骨存在；3耳锤骨、砧骨及镫骨均发育不全或缺如，均经完壁式上鼓室进路行听骨链松解术或听骨链成形术；8耳为砧骨长脚或镫上结构发育不全、镫骨缺如或镫骨异位，经耳道内进路完成前庭窗开窗与人工镫骨手术。16耳术后外耳道和鼓膜均保存或恢复完好，语频听力平均提高25～45dB。手术探查听骨链畸形与术前虚拟CT耳镜观察符合率为100％。结论：虚拟CT耳镜是中耳畸形术前评估的重要参考依据。

Objective：To evaluate the preoperative virtual CT endoscopy about the simple congenital middle ear malformations and its clinical application.Method：Thirteen cases（16ears）with simple congenital middle ear malformations were undergone high resolution CT scannig to collect the original image data,followed by 3-dimensional reconstruction to process the images to evaluate the possible lesions of the ossicular chain.Then,a comparative analysis was made between the finding of virtual CT endotoscopic and the finding that actually found during the operation of the ossicular chain lesions.Result：We found malleus and upper strcture of incus abnormity or embeded in upper inner wall of atticus in 5ears;malleus,incus and stape all abnormity or absence in 3ears,in the former two conditions we both selected auricular incision through attic pathway remaining intact canal wall;we found crus longum incudis hypoplasia orstructure suprastapedialis absence,stapes aberrance or absence in 8ears,then we selected vestibular window fenestration and artificial stapes surgery.Postoperative external auditory canals and tympanic membranes were intact in 16ears,and speech frequency hearing improved by average of 25-45dB.The coincidence between virtual CT endoscopy and the ossicular chain abnormity under operating views were 100%in cases with congenital ear deformity.Conclusion：Virtual CT endoscopy is a reliable reference for preoperative evaluation on congenital middle ear malformations.