23例儿童再次人工耳蜗植入手术的临床分析

Clinical analysis of cochlear reimplantation in 23 pediatric patients

目的分析23例人工耳蜗植入患儿再植入的原因、处理方法及预后。方法回顾性分析2013年9月—2019年6月行人工耳蜗再植入术患者的临床资料,分析再植入的原因、处理方法及预后。结果人工耳蜗植入后造成再植入的原因:外伤1例,手术固定电极不良1例,术区感染5例,排除言语处理器、手术植入及患者自身原因的助听效果差2例,不明原因植入体故障14例。5例感染患者均为一期行人工耳蜗取出,感染控制后行二期人工耳蜗手术,均为单耳再植入,2例同侧植入,3例对侧植入。23例患者首次均为右耳单侧植入,再次植入时2例患者行双侧人工耳蜗植入,3例患者改为对侧再次植入。再植入术后随访1个月至5年10个月,1例患者术中出现井喷,术后眩晕,3 d后缓解;1例患者出现头皮下血肿,术后2周内自行吸收。所有患者术后人工耳蜗听声效果正常。结论人工耳蜗再植入的原因有外伤、手术原因、感染、助听效果差、植入体故障,其中植入体故障和感染是儿童人工耳蜗再次植入的主要原因。再植入手术不影响人工耳蜗的效果,并发症发生率较初次手术无明显提高。为了减少人工耳蜗再植入,提倡精准的微创人工耳蜗植入预防并发症发生,同时加强对患者家长的教育,减少外伤等造成的人工耳蜗故障。

Objective To analyze the causes,treatment and prognosis of cochlear reimplantation in 23 pediatric patients.Methods Clinical data of 23 children underwent cochlear reimplantation in our center from September 2013 to June 2019 were reviewed.The reasons,treatment and prognosis of reimplantation were analyzed.Results Causes of the reimplantation included trauma(1 case),poor fixation of electrodes(1 case),infection in the surgical field(5 cases),poor hearing aid not resulted from wrong speech processor,surgery nor patients themselves(2 cases),unexplained implant failure(14 cases).In the 5 patients with infection,two-stage reimplantation was performed after removal of implant device and control of infection.Of them,2 underwent ipsilateral reimplantation and 3 underwent contralateral reimplantation.All the 23 patients received primary unilaterally implantation in the right ear.In the two-stage surgery,bilateral cochlear reimplantation was performed in 2 cases and contralateral reimplantation in 3.All the patients were followed up for one month to five years and ten months,and performed normal hearing by the cochlear system after reimplantation.During the follow-up period,dizziness occurred in one case with intraoperative gusher and got relieved within 3 days.Subscalp hematoma appeared in one and absorbed automatically within 2weeks.Conclusions Causes of the reimplantation include trauma,intraoperative poor fixation of electrodes,infection,poor hearing aid effect,unexplained implant failure.Device failure and infection are the most common causes.Cochlear reimplantation will neither increase incidence of complication nor affect surgical outcomes.To reduce the risk of reimplantation,accurate and minimally invasive cochlear implantation should be advocated to reduce surgical complications and the reinforcement of education for patients’family is also necessary to reduce the risk of trauma.