铒-钇铝石榴石激光辅助镫骨手术近期及远期疗效分析

目的 探讨铒-钇铝石榴石(Er-yttrium aluminum gamet,Er-YAG)激光辅助镫骨手术的近期和远期疗效.方法 回顾性分析2001-2007年间接受Er-YAG激光辅助足板小开窗镫骨手术的86例(99耳)病例,术前平均气骨导差(听力级)为(37.4±9.0)dB(x±s).分别以术后6周和大于1年的随访结果作为近期和远期疗效,远期随访时间14～73个月,平均(26.3±15.8)个月.同时观察术后有无耳鸣、眩晕及持续天数.结果 99耳术后近期气骨导差为(15.7±8.7)dB,与术前相比差异具有统计学意义(t=22.79,P<0.01).其中气骨导差小于10 dB或气导改善30 dB以上的为显效,共45耳(45.5%);气导改善15 dB以上为有效,共88耳(88.9%).82耳(82.8%)完成术后1年以上远期随访,平均气骨导差为(11.7±6.8)dB,与术前相比差异具有统计学意义(t=23.37,P<0.01);与这82耳的近期结果(15.3±9.2)dB]比较,差异具有统计学意义(t=4.82,P<0.01).其中显效共50耳(61.0%),74耳(90.2%)气骨导差小于20 dB.2 kHz骨导听阈术前平均为(34.5±15.0)dB,术后近期为(33.4±15.9)dB,远期为(32.7±15.2)dB,术前与术后近、远期自身比较,差异均具有统计学意义(t=1.96,P=0.026 14;t=3.24,P=0.000 87),提示卡哈切迹术后得以改善.4 kHz高频骨导听阈术后远期随}方结果和术前相比,差异无统计学意义(t=0.76,P>0.05).55耳术前有持续性耳鸣,术后42耳(76.4%)耳鸣消失,13耳耳鸣同术前;术后新发耳鸣3耳(3.0%),均于2～3 d后消失.12耳(12.1%)术后轻微眩晕,后均缓解,平均持续时间2.3 d,期间生活均能自理.结论 Er-YAG激光辅助镫骨手术对内耳具有较高的安全性,大大降低了镫骨手术的风险,疗效肯定.

Analysis of the short-term and long-term effect of Er-yttrium aluminum garnet laser In stapes surgery

Objective To analyze the short-term and long-term effect of Er-yttrium aluminum garnet (Er-YAG) laser in stapes surgery. Methods There were 86 patients operated by the Er-YAG laser stapedotomy from 2001 to 2007 were analyzed retrospectively, with 23 male,63 female and 13 double ears and with the average age of 48 years old, ranging from 12 to 78. All of 99 ears suffered deafness of conduction. The average air-bone-gap (ABG) of all patients before surgery was (37.4±9.0) dB HL (ranging from 13.7 to 58.7dB). The patients followed-up over 6 weeks after the surgery was regarded as the short-term result, while over one year follow-up as the long-term effect (according to the standard of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery). The followed-up average time was (26.3±15.8) months (range from 14 to 73 months). The pre-post-operafion average bone conduction auditory threshold of 2 kHz and 4 kHz were observed. The data of the patient whether or not has the symptoms of tinnitus and dizzy and the lasted days were also recorded. Results After surgery, short-term ABG of 99 ears was (15.7±8.7) dB, matched-pairs t test with the numbers of before surgery, t =22.79, P<0.01. The results of 45 ears (45.5%) with ABG<10 dB or air conduction improved more than 30 dB were regarded as excellence. The air conduction of 88 ears (88.9%)improved more than 15 dB was regarded as utility. With 82 ears (82.8%) followed-up more than 1 year, the average ABG was (11.7±6.8) dB, matched-pairs t test with the numbers of before surgery, t = 23.37, P<0.01, compared with the short-term visit result (15.3±9.2)dB, 82ears], t =4.82, P<0.01, beth of which were considered statistically extremely significant. Among them, 50 ears (61.0%) have the excellent effect while 74 ears with (90.2%) ABG<20 dB. The average bone conduction auditory threshold in 2 kHz was (34.5±15.0)dB before surgery, matched-pairs t test with short-term visit result (33.4±15.9) dB, t = 1.96, P = 0.026 14, with long-term visit result (32.7±15.2) dB, t = 3.24, P = 0.000 87, all of which had the significant difference, manifest that the Cohart's notch had been improved after the surgery. The data of bone conduction auditory threshold of 4kHz with long-term following-up result matched-pairs t test with that of surgery before, t = 0.76 (P>0.05), which showed the change of the bone conduction had no statistics difference. There were 55 ears had the persistent tinnitus before surgery, in which 42 ears (76.4%) with no the tinnitas, 13 ears with same to that of preoperative, and 3 ears (3.0%) with remaining tinnitus after surgery but who had not it preoperation and all disappeared after 2-3 days. There were 12 ears (12.1%) with light dizzy after surgery, but their live could deal with himself and the average dizzy lasted 2.3 days. Conclusions Er-YAG laser stapes surgery is safe to the inner ear, and it primal free from the immanent risk in stapes surgery, so the effect can be affirmed.