- 期刊
耳硬化症─25年鐙骨手術經驗
Otosclerosis-25 Year Experience on Stapes Surgery
摘要
背景：耳硬化症好發於白種人，而少見於黑種人及黃種人。本研究收集了國泰綜合醫院由1985年1月到2009年12月25年間所治療的耳硬化症病人，提出本院的病人疾病變程度，手術方法，及術後結果評估的綜合報告。方法：回溯分析由1985年1月到2009年12月25年間，共81次手術，67名患者的耳硬化症病例。此81次手術中有14名為接受雙側手術患者。手術中80耳採用由耳內進入中耳腔，僅1耳由耳後進入中耳腔。其中的耳（83%）施行鐙骨小窗手術，其餘8耳施行鐙骨部分切除手術，6耳施行鐙骨全部切除手術。植入人工替代品活塞型式皆為直徑0.4 mm，長度3.5－4.5 mm的Fisch Fluoroplastica & platinum piston。以純音聽力檢查（0.5 k，1 K，2 K，4 K）評估術前及術後的聽力改善的狀況。結果：患者的年齡分佈從17－61歲，女性49名，男性18名。兩側侵犯有38名（57%）。患者主訴的症狀以漸進性的聽力障礙和耳鳴為主。手術前純音聽力按查顯示氣骨導差平均為34 dB；鼓室壓力圖為As type者，有40耳；A type者，有40耳；C type者，有1耳。術後追蹤1年到12年，平均2.5年。術後氣骨導差在0－10 dB，44耳（54%）；0－15 dB，66耳（81%）。術中發現足板之病變型態多侷限在足板周圍之環狀韌帶及足板前端；少數為較為嚴重的整個足板變厚和卵圓窗病變侵犯。結論：國人耳硬化症的程度不若白種人嚴重，為變多侷限在足板周圍之硬化，而足板本身少有增厚的現象，所以在施行鐙骨小窗手術時，建議在做小窗之前，先保留砧骨－鎧骨關節的完整，增加施行鐙骨小窗造口時鐙骨的穩定性，以減少漂浮性足板和內耳傷害等併發症。本研究中將過去25年傳統性鐙骨手術方法和成果提出，以供參考。（台耳醫誌 2011；46：304－309）
並列摘要
BACKGROUND: Otosclerosis is an autosomal dominant disease affecting the otic capsule. It is rare in oriental people including Taiwan. The objectives of the study are to report the general epidemiologic profile of otosclerosis in Taiwan and to study of the effecetiveness of stapes surgery in our series.METHOD: From January 1985 to December 2009, 81 otosclerosis ears (67 cases) underwent primary stapes surgery under local anesthesia by the same ENT surgeon. Endaural approach was used in 80 ears and retroauricular approach was appliled to 1 ear. A platinum fluoroplastic piston of 0.4 mm diameter was used in the operation. Different from classic stapedectomy procedure, the perforation at the footplate is made before disarticulating the incudostapedial joint in this study. Effectiveness was assessed by using data obtained from pure-tone audiometry.RESULT: 49 (73%) cases were females. 18 (27%) were males. 38 cases (57%) were bilaterally affected. The average preoperative air-bone gap was 34 dB. The postoperative air-bone gap within 10 dB was 44/81 (54%), within 15 dB was 66/81 (81 %); and mean postoperative air-bone gap was 12 dB. Except for mild cochlear damage in one case (bone conduction hearing decrease 22 dB) and prosthesis displacement in one case, there were no serious complications after operation.CONCLUSION: The otosclerotic focus of stapedial footplate in Taiwanese mostly involves annular ligament and anterior footplate, which becomes fragile, vitreous and less resistant to trauma due to surgical manipulations. We suggest creation of the footplate fenestra using hand perforator before disarticulating the incudostapedial joint during the stapes surgery. This minimizes disturbance of the inner ear and reduces the risk of floating footplate. The minimal vestibular disturbance allows most patients to be discharged on the second day after surgery. (J Taiwan Otolaryngol Head Neck Surg 2011; 46:304-309)