不同类型先天性中耳畸形的手术治疗

Surgical treatment of different congenital middle ear malformation

摘要:

探讨先天性中耳畸形的临床分型及其手术策略。方法选取2016年6月—2019年12月收治的23例（33耳）先天性中耳畸形患者进行中耳畸形临床分型及不同的手术策略进行回顾分析，观察术后疗效和听力的恢复情况。术前对23例（33耳）中耳畸形患者均行耳内镜检查、听力学检查及颞骨CT并听骨链三维重建检查。结果23例患者中18例为术前明确畸形，5例为术中探查发现畸形。其中15例为锤、砧骨畸形，选择人工听骨赝复物（TORP或PORP）或自体听骨植入修复；6例为镫骨畸形，选择人工镫骨赝复物（Piston）植入；1例为鼓膜穿孔伴有先天性中耳畸形，先行鼓膜成形术，二期行听骨链重建手术；1例畸形程度比较复杂，面神经走形异常，在前庭窗处分叉，遮挡前庭窗，未能行进一步治疗。术后气导阈值提高至正常的有15例（65.2%）；骨气导差（ABG）恢复至30 dB以内的有16例（69.6%），ABG术后仍超过30 dB的有5例（21.7%），1例听力未改善（4.3%），1例无法行听骨重建（4.3%）。结论先天性中耳畸形术前诊断比较困难，CT检查很难精确评估，手术探查为最有说服力的诊断标准，明确中耳畸形临床分型后选择最佳的手术方式，是治愈疾病并提高患者术后听力最佳选择。

关键词:先天性中耳畸形|临床分型|人工听骨赝复物|手术策略

Abstract:

ObjectiveTo explore the clinical classification and surgical strategy of congenital middle ear malformation.MethodsA total of 23 patients (33 ears) with congenital middle ear malformation admitted to our hospital from June 2016 to December 2019 were selected. The clinical classification of middle ear malformation and different surgical strategies were retrospectively analyzed to observe the postoperative efficacy and hearing recovery. All 23 cases (33 ears) with middle ear malformation were examined by ear endoscopy, audiology, temporal bone CT and threedimensional reconstruction of ossicular chain.ResultsEighteen of the 23 patients were confirmed for middle ear malformation preoperatively. And intraoperatively, 5 cases were identified for middle ear malformation. For 15 cases of them,malformation of hammer and anvil, artificial ossicles (TORP or PORP) or autogenous ossicles were selected for repair. Implantation of an artificial stapes (Piston) was selected for 6 patients with the malformed stapes. One patient was diagnosed with tympanic membrane perforation and congenital middle ear malformation, who was performed first tympanoplasty, then reconstruction of auditory chain in the second stage. The deformity of 1 case is more complex, which was bifurcated and blocked the vestibular window, and failed to perform a surgical treatment. After operation,there were 15 cases (65.2%) with normal airway threshold, and 16 cases (78.3%) with airbone gaps(ABG) within 30dB. There were 5 cases (21.7%) with ABG still exceeding 30dB after operation, 1 case (4.3%) with no hearing improvement, and 1 case (4.3%) without audioplasty.ConclusionsIt is difficult for preoperative diagnosis of congenital middle ear malformation. Preoperative CT examination is difficult to evaluate this disease accurately.Surgical exploration of congenital middle ear malformation is the most convincing diagnosis.The choice of the best surgical method is to cure the disease and improve the hearing after middle ear malformation after clarifying the clinical classification of middle ear malformation.

Key words:Congenital middle ear malformation|Clinical classification|Ossicular replacement prosthesis|Surgical strategy