锤骨前庭桥接术应用于听骨链重建的远期效果分析

王晓茜; 黄宏明; 葛润梅; 黄艳; 许咪咪; 汪菊萍; 黄东华; 黄韵烨; 莫烨菲; 林晓德; 吴佩娜

doi:10.13201/j.issn.2096-7993.2020.10.005

锤骨前庭桥接术应用于听骨链重建的远期效果分析

- 广东省医学科学院广东省人民医院耳鼻咽喉科(广州，510080)

详细信息

通讯作者: 吴佩娜，E-mail：linwupeina@hotmail.com

中图分类号: R764.32

收稿日期: 2020-06-10

刊出日期: 2020-10-05

The long term effect of malleostapedotomy in ossicular chain reconstruction

- Department of Otorhinolaryngology, Guangdong Academy of Medical Sciences & Guangdong Provincial People's Hospital, Guangzhou, 510080, China

More Information

Corresponding author: WU Peina, E-mail: linwupeina@hotmail.com

Received Date: 10 June 2020

Publish Date: 05 October 2020

摘要

摘要: 目的分析锤骨前庭桥接术(MT)应用于听骨链重建的远期效果。方法回顾性分析应用MT技术重建中耳传声功能并获得远期随访的11例(12耳)患者资料, 统计术前、术后1周和术后≥1年的听力结果, 根据术中发现、手术并发症及术后听力效果, 探讨此术式的适应证, 评估其远期安全性和有效性。结果 11例(12耳)中, 鼓室硬化1例(1耳), 先天性听骨链畸形3例(4耳), 耳硬化症5例(5耳), 局灶性中耳胆脂瘤2例(2耳)。所有患者术后2周内均无骨导听力下降(骨导损失超过10 dB); 4例术后短暂眩晕, 平均3 d缓解; 2例局灶性中耳胆脂瘤患者无复发。随访1~6年, 全部患者气导改善显著, 无骨导下降, 气骨导差术前与术后的差异有统计学意义(P < 0.05)。结论在严格掌握手术适应证的前提下, MT远期效果安全有效, 适用于多种原因导致的伴有锤砧传声功能障碍的镫骨或底板固定的听骨链重建。
- 锤骨前庭桥接术 /
- 镫骨手术 /
- 耳硬化症 /
- 听骨链重建 /
- 远期效果
Abstract: Objective To analysis the long-term outcomes of ossicular chain reconstruction using the malleostapedotomy(MT).Method A total of 11 patients(12 ears) underwent MT and their hearing levels were measured prior to surgery, 1 week and more than 1 year after surgery. The indications of MT were discussed and its safety and efficacy were evaluated in terms of the intra-operative findings, post-operative hearing and complications.Result Among 11 patients(12 ears), there were 1 patient(1 ear) with tympanosclerosis, 3 patients(4 ears) with ossicular chain deformity, 5 patients(5 ears) with otosclerosis and 2 patients(2 ears) with localized cholesteatoma of the middle ear. No cases of bone conduction hearing loss(more than 10 dB) were observed within 2 weeks after surgery while four patients suffered from short-term vertigo with an average remission duration of 3 days. And no recurrence was found in the two patients with cholesteatoma. After a follow-up of 1-6 years, we found a remarkable improvement of air conduction without bone conduction loss in all patients and there was a significant difference between preoperative and post-operative air-bone gap(P < 0.05).Conclusion With a strict selection according to the indications, MT showes safe and effective long-term outcomes and is proved to be applicable in ossicular chain reconstruction in the cases of fixation of the stapes footplate accompanied with malleus/incus mobility disorder by various causes.
- malleostapedotomy /
- stapes surgery /
- otosclerosis /
- ossicular chain reconstruction /
- long-term outcome

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图 1 经镫骨底板开窗MT

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图 2 镫骨底板全切除MT

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表 1 11例(12耳)患者MT术中所见

例序	诊断	手术侧别	术中所见	术中处理
1	鼓室硬化	左	初次探查全听骨固定，鼓岬黏膜受累，底板固定；1年后二期手术发现鼓膜完整与锤骨柄连接良好，底板再固定，中耳含气	一期清除病灶，修补鼓膜，保留锤骨柄及镫骨底板；二期底板全切MT
2	听骨链畸形(马凡综合征)	左	全听骨粗大，锤砧关节活动差，镫骨底板固定	小孔窗MT
3	听骨链畸形(马凡综合征)	右	全听骨粗大，锤砧关节活动差，镫骨底板固定	小孔窗MT
4	听骨链畸形	右	镫骨底板固定，镫骨体细小，砧骨长脚短小，砧镫失连接	小孔窗MT
5	耳硬化症	左	合并锤砧关节活动差	小孔窗MT
6	耳硬化症	左	合并锤砧关节活动差	小孔窗MT
7	耳硬化症	右	合并锤砧关节活动差	小孔窗MT
8	耳硬化症	左	操作失误导致锤砧关节脱位	小孔窗MT
9	听骨链畸形	右	锤砧关节融合，板上结构及砧骨长脚缺失，面神经脱垂并遮盖前庭窗2/3，镫骨底板固定	小孔窗MT
10	耳硬化症	右	合并锤砧关节活动差	小孔窗MT
11	局灶性中耳胆脂瘤	右	鼓膜完整，中耳局限胆脂瘤上皮，破坏砧骨长脚及镫骨，清除胆脂瘤后见底板部分破坏，前庭池裸露	底板全切MT
12	局灶性中耳胆脂瘤	左	鼓膜完整，中耳局限胆脂瘤上皮，破坏砧骨长脚及镫骨，清除胆脂瘤后见底板部分破坏，前庭池裸露	底板全切MT

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表 2 11例(12耳)患者术后近期、远期纯音骨导比较

例序	术前骨导	术后近期骨导 (2周内)	近期骨导差 (2周内)	术后远期骨导 (1年以上)	远期骨导差 (1年以上)
1	11	19	8	16	5
2	18	10	-8	13	-5
3	6	8	2	11	5
4	6	3	-3	15	9
5	40	41	1	39	-1
6	50	50	0	54	4
7	22	29	7	24	2
8	35	31	-4	33	-2
9	36	20	-16	20	-16
10	27	9	-18	23	-4
11	17	14	-3	22	5
12	41	40	-1	36	-5

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表 3 术后远期ABG与术前ABG比较

例序	术前			远期			术前与远期ABG之差
例序	骨导	气导	ABG	骨导	气导	ABG	术前与远期ABG之差
1	11	55	44	16	46	35	9
2	18	67	49	13	13	-5	54
3	6	60	54	11	11	5	49
4	6	59	53	15	20	14	39
5	40	73	33	39	47	7	26
6	50	91	41	54	63	13	28
7	22	77	55	24	41	19	36
8	35	55	20	33	40	5	15
9	36	67	31	20	36	0	31
10	27	73	46	23	23	-4	50
11	17	62	45	22	41	24	21
12	41	88	47	36	51	10	37

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参考文献(11)

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