人工耳蜗植入术:附70例临床分析

【目的】探讨人工耳蜗植入术的有关问题。【方法】对2002年1月至2005年12月施行的人工耳蜗植入术70例的临床资料进行回顾性分析。【结果】60例正常结构耳蜗患者均经常规方法顺利植入,插入电极达到常规要求;10例异常结构耳蜗患者中,3例为大前庭导水管综合征患儿,1例术中可见外淋巴液波动,另1例出现“井喷”,但均顺利完全插入电极并用颞肌筋膜成功封闭鼓阶小窗,阻止“井喷”和外漏;2例共同腔畸形患儿只能插入部分(15和17个)电极;1例Pendred(甲状腺肿耳聋)综合征并小耳蜗畸形患儿在治疗甲状腺功能低下后接受手术并顺利完全插入电极;1例内听道狭窄患儿有残余听力,顺利接受了植入手术,术中术后未发生脑脊液漏;3例耳蜗骨化患儿中,2例不完全骨化可完全插入电极(其中1例为经前庭阶插入),另1例完全骨化,术中与其家长及语训老师讨论后放弃手术。术后除1例6岁患儿出现暂时性面瘫并于第7天完全恢复外,无其他并发症。成功植入电极的患者均正常“开机”并且均有听觉反应。【结论】成功的人工耳蜗植入有赖于手术前详细分析病史和影像学资料,充分估计术中的困难,与患者及其家属讨论病情和术中的规范操作。

Cochlear Implantation: a Clinical Analysis of 70 Cases

Objective To explore the problems related to cochlear implantation.Method Retrospective study of 70 cases with cochlear implantation from January 2002 to December 2005.Results The cochlear implants were successful in 60 cases with normal cochlea by a routine implant method.Among 10 cases with abnormal cochlea,1 of 3 cases with large vestibular aqueduct syndrom had "gush",while another 2 case had only slight leakage of perilymph.These 3 cases were sucessfully inserted all electrodes and stopped gush or leakage by using temporal fascia.Two cases with common cavity,the electrodes were partially inserted(15 and 17).One case with Pendred syndrom and small cochlea,got successfully implantation after thyroidotherapy.One case with narrow internal acoustic canal with residual hearing underwent sucessful implantation without leakage of cerebrospinal fluid.Three cases of cochlea ossification,total insertion were performed in 2 partial ossified cochlea(one with insertion via vestibular scala),and gave up in another total ossification after a intraoperative discusion with the parents and teachers.No complication was found except a temporal facial paralysis in a six-year girl.All cases with sucessful insertion had normal "switch on" and expected sound reaction.Conclusion The successful rate of cochlear implants may be enhanced by good preoperative preparation,including detail evaluation of history,careful analysis of imaging materials and thorough discussion,and also by exactly intraoperative performance.