小儿人工耳蜗植入手术切口选择及其相关并发症问题

目的探讨小儿人工耳蜗植入手术的切口选择。方法回顾性分析2001年6月～2007年7月开展的5岁以下患儿人工耳蜗植入手术589例,均设计小“S”切口。其中,行澳大利亚CI24M植入174例,切口长3.5cm;CI24CA植入137例,CI24K植入62例,切口均长3.0cm。行美国Bionics90K植入26例,切口长3.5cm。行奥地利MedelCombi40^＋植入190例,切口长6.0cm。均制备两个肌骨膜瓣,一个用于包裹植入体,另一个用于覆盖开放的乳突腔。术后随访6个月～6.5年,观察术后切口愈合状况以及与切口有关的并发症发生情况。结果植入的人工耳蜗均有听觉语言效果。12例于术后1～2年开始沿切口表面出现1.5～3.5mm的瘢痕隆起（2.0%）;4例于术后1～3年出现与皮下感染有关的植入体裸露（0.68%）。通过清除炎症及瘢痕组织、重新固定植入体、颞肌瓣转移覆盖均获痊愈,随访6个月～2.1年,未再出现植入体裸露。结论作者设计的小切口效果满意,可以减小皮肤切口瘢痕的范围,术后植入体裸露的发生率低。

Discussion on Operative Incision of Cochlear Implant for Children

Objective To explore the decision on the operating incision choice for cochlear implant among children so as to prevent the incision related complications in cochlear implant from occurring. Methods A retrospective study was carried out among 589 children cases undergone cochlear implant surgery for their profound hearing loss below the age of 5 years old, performed from Jun, 2001 to Jul, 2007 and all operated on with a small ＂S-shaped＂ incision. Among these treated cases, 174 were implanted with Australia Device CI24M with the incision being 3.5 cm long, while 137 were implanted with Australia Device CI24CA and 62 implanted with Australia Device CI24K, all the cases in both sub-groups with the incision being 3.0 cm in their length. Twenty six cases were implanted with American Device Bionics 90K with the incision being 3.5 cm long, and 190 cases were implanted with Austria Device Medel Combi 40^＋, with the incision being 6.0 cm in their length. Two muscle-periosteum flaps were prepared during the operating process, with one flap used to wrap up the implant button and the other one to cover the opened mastoid cavity. Then, all the children cases were followed up for 6 months to 6.5 years respectively to observe the healing status of the wound and the incidence of various kinds of operating incision-related complications. Results All these children cases undergone cochlear implant were observed with more ideal auditory and speech outcome. However, 12 were found with scar protrusion in a length of 1.5 to 3.5 cm along the surface of incision 1 to 2 years following the operation, with an incidence rate of 2.0%, and 4 （0.68%） were observed with the implanted device exposure 1 to 3 years after the surgery, perhaps associated with postoperative infection, among all these operated cases. The latter 4 cases with such a complication of implanted device exposure were all cured without the condition reoccurred any more following the cleaning up of inflammatory and scar tissues and retightening of the implant button