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摘要: 目的 分析人工耳蜗再植入患儿的临床特点，总结术中的各种问题和应对措施，为人工耳蜗再植入手术以及为避免出现相关问题而在初次植入中应注意的事项提供参考。方法 回顾性分析2018年7月—2022年7月在北京大学第三医院耳鼻咽喉科行人工耳蜗再植入术的32例患儿资料，再植入距离初次植入的时间为1~8年。术后4周重新开机，评估人工耳蜗工作情况及患儿听觉情况。结果 术中特殊情况包括不同程度及部位的骨质增生(其中2例耳蜗造孔骨质增生明显，1例导线骨槽骨质增生明显)32例、重要骨性结构(包括骨性外耳道后壁、面神经乳突段骨管、接收-刺激器骨床等)缺损5例、胆脂瘤形成1例、术腔其他病变或异物4例、耳蜗内电极位置异常(部分脱出或电极背向蜗轴)4例等。均顺利完成再植入手术，无并发症发生，术后恢复及开机均顺利。结论 在初次人工耳蜗植入时应注意尽量保留残余听力、充分考虑术后骨质增生可能、避免大量应用不可吸收粘合材料、避免面神经管及外耳道后壁等重要结构损伤、植入电极时注意深度及朝向等。在人工耳蜗再植入术中应充分考虑上述“隐性损伤”的可能性，避免发生新的损伤或并发症。Abstract: Objective To summarize the clinical characteristics of children undergoing surgery of cochlear reimplantation, focus on various problems and management in cochlear reimplantation, in order to avoid related problems in surgery of cochlear reimplantation and the initial implantation.Methods A total of 32 children who underwent cochlear reimplantation in Peking University Third Hospital from July 2018 to July 2022 were retrospectively analyzed, and the duration from the initial implantation was from 1 year to 8 years. The cochlear implant mapping was performed 4 weeks after the operation, and the auditory performance was evaluated.Results Special intraoperative issues included 32 cases with bone and soft tissue hyperplasia at various sites(2 cases with obvious bone hyperplasia in cochlear window, 1 case with obvious bone hyperplasia in subperiosteal tunnel of wire), 5 cases with bone defects in important structures(including the posterior wall of the external auditory canal, the facial nerve canal, and the subperiosteal pocker of the receiver-stimulator), 1 case with cholesteatoma, 4 cases with other lesions or foreign bodies, 4 cases with abnormal position of the electrodes(migration or reversal). All operations were successfully completed without complications. Postoperative recoveries were smooth.Conclusion In the initial cochlear implantation, attention should be paid to retain residual hearing as much as possible, fully consider the possibility of postoperative bone hyperplasia, avoid large amounts of non-absorbable adhesive materials, avoid bone defects in important structures(such as facial nerve canal or posterior wall of the external auditory canal), pay attention to the depth and orientation of electrode implantation. The possibility of "hidden injury" mentioned above should be fully considered in surgery of cochlear reimplantation to avoid new injury or complication.
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Key words:
- child /
- cochlear implantation /
- reimplantation /
- complications
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