人工耳蜗植入术后再次手术的原因分析

Causes of Revision Surgery after Cochlear Implantation

目的总结分析人工耳蜗植入患者植入侧再次手术的发生率、原因、临床处理方法、预防措施及预后。方法对2003年1月至2018年10月在我科施行的1689例人工耳蜗植入手术进行回顾性分析研究。结果在所有研究对象中,有21例共接受再次手术,再次手术发生率为1.24%。其中8例因皮瓣相关并发症行植入侧再次手术,发生率为0.47%,2例因皮瓣过厚导致外机磁铁无法吸附行皮瓣修整,6例因皮瓣反复红肿、渗出、坏死反复保守治疗无效最终取出原植入体,其中2例接受了对侧人工耳蜗植入术,所有患者术后未出现皮瓣相关并发症。5例患者因植入体故障再次手术、发生率为0.29%,其中4位出现植入体不能正常工作,1位因植入体磁铁移位导致局部皮肤破溃。3例表现为耳后脓肿,行脓肿切开引流并换药后治愈,发生率为0.18%。3位患者因电极异常植入而立即再次手术重新植入、发生率为0.18%。1例因术后发现植入耳外耳道胆脂瘤突入中耳腔手术清除病变,发生率为0.06%,手术治疗后目前随访恢复良好。结论人工耳蜗植入手术同侧再次手术的常见原因皮瓣相关并发症、植入体故障,对于年幼的患儿感染也可能是再次手术的重要原因,对于内耳畸形及术中圆窗暴露不佳的患者因警惕电极异常植入而导致的再次手术。

Objective To review revision surgery in patients following cochlear implantation for causes,management and outcomes.Methods Data from 1689 patients who received cochlear implant surgery between Jan 2003 and Oct 2018 at the Frist Afflicted Hospital of USTC were retrospectively reviewed.Results Twenty one patients(1.24%)received revision surgeries.Revision was needed for flap related complication in 8 cases(0.47%):flap had to be thinned in 2 cases to improve magnets coupling,and implants had to be was removed in 6 cases due to repeated skin flap redness,swelling,exudation and necrosis.Secondary surgery was for contralateral cochlear implantation in 2 cases with no flap related complications.Implant issues were the reason for revision in 5 patients(0.29%)including implant failure(n=4)and implant magnet displacement with skin rupture(n=1).Ear abscess requiring drainage and antibiotics occurred in 3 cases(0.18%).Another 3 patients(0.18%)underwent immediate re-implantation due to misplacement of electrode array.One patient(0.06%),was operated upon for cholesteatoma.Conclusion Common causes for ipsilateral revision after cochlear implant surgery are flap related complications,especially in young children,and implant failure.Revision for aberrant electrode placement is more common in patients with inner ear malformation or narrow round window.