24例儿童人工耳蜗再植入相关问题分析

The Analysis of Issues Related to Cochlear Reimplantation in 24 Pediatric Patients

目的报告分析儿童人工耳蜗再植入的常见原因、手术方法及术中所发现的相关问题,探讨原刺激电极在儿童再次人工耳蜗手术中的参考作用。方法回顾分析2009年6月~2018年12月河南省儿童医院24例行人工耳蜗再植入术患者的临床资料,就再植入原因、儿童人工耳蜗再植入的手术方法、术中组织增生对于手术实施的影响等因素进行分析,进一步探究,基于原刺激电极形成的窦道,顺势导入电极的优势及术中出现的问题,明确其参考价值。结果24例人工耳蜗再植入病例,男13例,女11例,年龄2~13岁,中位年龄5.79岁,再次植入与首次手术的间隔时间1~4年。20例患儿顺利完成同侧人工耳蜗再植入手术。4例患儿行对侧人工耳蜗植入,其中3例因皮瓣感染坏死,1例因电极过早退出找不到原耳蜗造瘘口。再植入原因:不明原因植入体故障11/24例(45.83%),外伤后植入体线圈金属丝断裂7/24(29.17%),明确头部外伤后电极阻抗值升高2/24(8.33%),因车祸伤致植入体及电极脱出1/24(4.17%),植入体处皮瓣感染坏死3/24(12.5%)例。术中发现:乳突部骨皮质增生20/24(83.33%)例,植入体周围纤维结缔组织或水肿的组织包裹23/24(95.83%)例,植入槽纤维组织及骨质增生22/24(91.67%)例,面神经隐窝内结缔组织及骨质增生16/24(66.67%)例,耳蜗开窗处(原电极入耳蜗处)有结缔组织增生、粘连24/24(100%)例。结论植入体故障是再次植入耳蜗的首要原因。人工耳蜗植入体周围炎症反应、乳突骨皮质增生、植入槽结缔组织和骨质增生、面神经隐窝及耳蜗造瘘口结缔组织和骨质增生常造成手术难度加大。术前检查及第一次手术情况复习可以预估术中出现的情况,特别是原刺激电极进入耳蜗造瘘口位置的参考作用尤为重要,可减少手术风险确保手术成功。同时术后预防头部外伤也是避免人工耳蜗再植入的一个重要方面。

Objective To analyze the common causes and surgical methods of cochlea reimplantation in children,and the problems met during the surgery,and to discuss the reference role of former stimulating electrode in cochlea reimplantation in children.Methods Clinical data of 24 children underwent cochlear reimplantation in Henan Children's Hospital from June 2009 to December 2018 were reviewed retrospectively.The causes of reimplantation,surgical methods of cochlea reimplantation in children and the effect of hyperplastic tissue on operation difficulty were analyzed,Further,we have explored the advantages of homeopathic introduction of electrodes under the sinus tract formed by the original stimulation electrode and the issues encountered during the operation to clarify its reference value.Result There were 24 patients aged 2~13 years,and 13 of them are male,11 of them are female.The median age is 5.79.The interval between reimplantation and the first operation is 1~4 years.20 children have successfully completed ipsilateral cochlear implantation.4 children underwent contralateral cochlear implantation,three of which were due to infection and necrosis of the skin flap,and one patient could not find the original cochlear fistula due to premature electrode withdrawal.The causes of reimplantation:11 cases(45.83%)of unexplained implant malfunction,7 cases(29.17%)of fracture of wire in implantable coil caused by trauma,2 cases(8.33%)of increased electrode impedance after head trauma,1 case(4.17%)of implant and electrode prolapse caused by car accident,3 cases(12.5%)of infection and necrosis of skin flap at implantation site.Intraoperative findings:20 cases(83.33%)of cortical hyperplasia at mastoid,23 cases(95.83%)of wrapped implants by connective or edematous tissue,22 cases(91.67%)of fibrous tissue and osseous hyperplasia in the implant socket(slot\groove),16 cases(66.67%)of connective tissue and osseous hyperplasia in the facial nerve crypt,All the 24 cases(100%)of connective tissue hyperplasia and adhesion in the cochlea window(the location of the former electrode entering cochlea).Conclusion The implant malfunction is the leading cause of cochlea reimplantation.Unclear anatomical structures due to inflammatory responses around cochlear implants,hyperplasia of the mastoid cortex and implantation slots,facial nerve crypts,connective tissue of the cochleostomy fistula,and bone hyperplasia may make surgery difficult.Preoperative examination and review of the first surgery can predict the situation during the operation.The reference role of the original stimulation electrode entering the cochleostomy fistula is particularly important,which can reduce the risk of surgery and ensure the success of the operation.In addition,preventing head trauma after surgery is important to avoid reimplantation of cochlear implants.