改良耳后反S形双瓣技术在电子耳蜗植入手术中的临床应用研究
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摘要
目的研究一种新的电子耳蜗植入手术耳后手术切口和皮瓣的制作方法,以降低电子耳蜗植入术后并发症的发生率。方法回顾性研究。收集2009年10月～2016年9月在我院行改良耳后反S形双瓣技术电子耳蜗植入手术的重度或极重度感音神经性耳聋患者174例(179耳),其中右耳135例、左耳34例、双耳5例,观察术后并发症及伤口愈合情况。结果所有病例均未发生皮瓣坏死和电子耳蜗植入体排出等严重并发症。1例患者发生皮下血肿,经加压包扎后消退;1例术后1周伤口延迟愈合,2周后愈合,切口无明显感染迹象。结论改良耳后反S形双瓣技术可以满足电子耳蜗植入对皮瓣和切口的要求,能够有效地暴露术区便于移植物骨床的制作,以及减少对皮瓣和肌骨膜瓣血供的影响。
Objective To study a new method of making ear incision and flaps for cochlear implantation in order to reduce the incidence of complications after cochlear implantation. Methods Retrospective study. From Oct.2009 to Sep 2016,174 patients with severe or very severe sensorineural deafness who had undergone modified S-shaped double-flap electron cochlear implantation surgery at the Department of Otolaryngology of Fudan University were analyzed. There were a total of 179 ears include of 135 cases in the right ear,34 cases in the left ear and 5 cases in both ears. The postoperative complications and wound healings were observed. Results All the cases with this modified S-shaped double-flap technique did not have serious complications such as flap necrosis or electron cochlear implant discharge. One patient developed subcutaneous hematoma and disappeared after pressure bandaging. Another case had the wound healed after two weeks,but there was no obvious sign of infection in the incision. Conclusions The modified S-shaped double-flap technique can meet the requirements of the flap and the incision of the cochlear implantation. It can effectively expose the operation area to facilitate the preparation of the graft bone bed and reduce the impact on the blood supply to the flap and muscle flap.
Objective To study a new method of making ear incision and flaps for cochlear implantation in order to reduce the incidence of complications after cochlear implantation. Methods Retrospective study. From Oct.2009 to Sep 2016,174 patients with severe or very severe sensorineural deafness who had undergone modified S-shaped double-flap electron cochlear implantation surgery at the Department of Otolaryngology of Fudan University were analyzed. There were a total of 179 ears include of 135 cases in the right ear,34 cases in the left ear and 5 cases in both ears. The postoperative complications and wound healings were observed. Results All the cases with this modified S-shaped double-flap technique did not have serious complications such as flap necrosis or electron cochlear implant discharge. One patient developed subcutaneous hematoma and disappeared after pressure bandaging. Another case had the wound healed after two weeks,but there was no obvious sign of infection in the incision. Conclusions The modified S-shaped double-flap technique can meet the requirements of the flap and the incision of the cochlear implantation. It can effectively expose the operation area to facilitate the preparation of the graft bone bed and reduce the impact on the blood supply to the flap and muscle flap.
引文
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[11] DUTT S N,RAY J,HADJIHANNAS E,et al. Medical and surgical complications of the second 100 adult cochlear implant patients in Birmingham[J]. J Laryngol Otol,2005,119(10):759-764.
[12] Alzoubi F,ODAT H,AL OMARI A,et al. The outcome of our modified double-flap technique for cochlear implantation:a case series of 342 consecutive patients[J]. Cochlear Implants Int,2015,16(2):95-99.
[2] O'DONOGHUE G M, NIKOLOPOULOS T P. Minimal access surgery for pediatric cochlear implantation[J]. Otol Neurotol,2002,23(6):891-894.
[3] GIBSON W P,HARRISON H C,PROWSE C. A new incision for placement of cochlear implants[J]. J Laryngol Otol,1995,109(9):821-825.
[4] CLARK G M,PYMAN BC,BAILEY Q R. The surgery for multipleelectrode cochlear implantations[J]. J Laryngol Otol,1979,93(3):215-223.
[5] Franz B K,KUZMA J A,LEHNHARDT E,et al. Implantation of the Melbourne/Cochlear multiple-electrode extracochlear prosthesis[J]. Ann Otol Rhinol Laryngol,1989,98(8):591-596.
[6] PARISIER S C, CHUTE P M, POPP A L. Cochlear implant mechanical failures[J]. Am J Otol,1996,17(5):730-734.
[7] RAY J,GIBSON W,SANLI H. Surgical complications of 844consecutive cochlear implantations and observations on large versus small incisions[J]. Cochlear Implants Int,2004,5(3):87-95.
[8] HARRIS J P,CUEVA R A. Flap design for cochlear implantation:avoidance of a potential complication[J]. Laryngoscope,1987,97(6):755-757.
[9] HABERKAMP T J,SCHWABER M K. Management of flap necrosis in cochlear implantation[J]. Ann Otol Rhinol Laryngol,1992,101(1):38-41.
[10] BAYAZIT Y A,GOKSU N,OZBILEN S. Mini-incision for pediatric cochlear implantation with a MED-EL device[J]. ORL J Otorhinolaryngol Relat Spec,2007,69(5):311-315.
[11] DUTT S N,RAY J,HADJIHANNAS E,et al. Medical and surgical complications of the second 100 adult cochlear implant patients in Birmingham[J]. J Laryngol Otol,2005,119(10):759-764.
[12] Alzoubi F,ODAT H,AL OMARI A,et al. The outcome of our modified double-flap technique for cochlear implantation:a case series of 342 consecutive patients[J]. Cochlear Implants Int,2015,16(2):95-99.