摘要
目的 :总结铒 -YAG激光在中耳手术中的应用效果。方法 :为 9例、1 0耳施术 ,男 3例、3耳 ,女 6例、7耳 ,2 0～ 64岁 ,平均 45岁。耳硬化症镫骨手术 6耳 (3耳再手术 ,2耳伴锤骨前韧带骨化 ) ,其他手术 4耳(3耳鼓室成型 1 0～1 5年后传导聋再发 ,术中见镫骨周围钙化、骨化 ,1耳耳鸣 ,听力轻度下降 ,检查见鼓膜松弛部黏连 ,术中见鼓环上切迹与锤骨颈部骨性黏合)。手术设备为TwinER -YAG(铒 :钇铝石榴石二合一 )激光系统 ,与OMPI手术显微镜相配套。激光使用参数 :一般用 5 0mJ,连续脉冲。结果 :随访 3个月以上 ,术后听力平均缩小 3 1dB ,9例气骨差小于 2 0dBHL ,7例气导小于 40dBHL。其中 6耳镫骨手术 ,术后气骨差均缩小 3 7dBHL,气导全部在 2 0dBHL以内 ,其中 3耳在 1 5dBHL以内 ,1耳闭合。1 0耳术后全部无眩晕。 1 0耳术前均有程度不同的耳鸣 ,术后 8耳消失 ,1耳减轻 ,1耳仍有 (严重鼓室硬化症 ,镫骨周围钙化、骨化包裹 )。结论 :铒 -YAG激光用于治疗耳硬化症和鼓室硬化症安全高效 。
Objective:To assess the result with Er:YAG in stapedotomy and tympanoplasty. Method:9 cases(10 ears)were analyzed retrospectively.3 cases were man,6 cases were female aged 20 to 64 years.6 ears were performed stapedotomy by otosclearoses(3 ears were reoperated and 2 ears had ossification of malleus neck ligment).3 ears were performed re-tympanoplasty after primary operation 10～15 years,and had mass of ossification of calcification around stapes.1 case had tinnitus and light deafness,and had adhesion at malleus neck and a small retract pocket,in operation was observed ossification at attic wall and malleus neck.The device was Twin Er:YAG laser combined microscope from Carl Zeiss.The laser was commonly 50 mJ for one operation,continues pulses.Result:10 ears were followed up over 3 months,with the gap reduced 31 dB in average,9 ears' gap was less than 20dB HL,7ears'air conduction was less than 40dB HL.Of 6 ears were stapedotomied,their postoperation gap reduced over 37 dB HL,and air conduction were all in 20 dB HL.All hadn't vertigo postoperation.After operation 8 ears had no tinnitus,1 ear improved,and 1 still had. Conclusion:Er-YAG laser is a safe,effect device for stapedotomy or tympanoplasty.No injury in inner ear occur.
基金
上海市跨世纪学科带头人培养计划资助项目 (0 2 3)
