幼兒人工耳蝸植入手術耳後切口的改良

Modification of Post-auricular Incision for Pediatric Cochlear Implantation

吳俊良(Jiunn-Liang Wu) ； 林政佑(Cheng-Yu Lin)

《台灣耳鼻喉頭頸外科雜誌》 39卷4期 (2004/10) Pp. 140-144

https://doi.org/10.6286/2004.39.4.140

摘要

背景：人工耳蝸植入已被證實能有效改善極重度聽障兒童的聽覺，當確定孩童無法從助聽器得到足夠的聽能輔助時，便應及早接受手術，以利語言發展。然而，有些家長會畏懼植入手術，遂令其小孩延誤聽語復健的時機，其中的原因包括手術造成的大傷口及擔心手術併發症。因此改善手術傷口大小與外觀，以及降低手術併發症，應該是可以提高孩童的家長對人工耳蝸值入的接受度。本研究的目的便是在設法縮小人工耳蝸手術的傷口大小，期盼能改善傷口外觀，同時維持低的併發症比例。
方法：利用一般鼓室成形術所用的耳後切口(post-auricular incision)作為手術的切口，其次作較大範圍的皮下剝離，以便建構一基部在前方的骨膜辦(anterior based periosteal flap)，此時由於手術視野小與角度限制的關係，術者可能需要利用手術台的雙側輪流操作。其餘的手術步驟皆與之前的手術完全相同。
結果：自2002年12月至2003年11月期間，以新的手術方式執行人工耳蝸手術於8名病色，其平均接受開刀的年齡為3.7歲（範圍2.3-7.4歲）。結果發現術後傷口比原先所使用的倒〝J〞切口小，住院天數未延長，所有病患均未發生術後的併發症。家長則均主觀認定改善方法後的傷口在外觀上優於之前的。
結論：改良型的幼兒人工耳蝸植入手術耳後切口是可嘗試的手術方法，它確實能夠創造較小的植入手術傷口，改善外觀。同時，依舊保留骨膜辦，有效保護著植入體，故仍能維持手術的低併發症比例。

關鍵字

耳後切口 ； 人工耳蝸植入

並列摘要

BACKGROUND: Cochlear implantation is an effective procedure that can restore hearing in children with severe to profound hearing impairment. The procedure, when performed in experienced centers, also has a very low rate of serious complications. Surgical intervention should therefore be considered early on in deaf children to promote language development when hearing aids are found to be inadequate for auditory rehabilitation. Some parents are fearful of implantation because of the obvious incision wound and the potential for complications. Any improvement in the cosmetic effects of the procedure would therefore make it more acceptable. This study aimed to develop a minimally invasive cochlear implantation procedure that would help to make the entire surgical process more acceptable to the children and their families without compromising surgical safety.
METHODS: The modified procedure for cochlear implantation uses a post-auricular incision, not unlike the skin incision used for tympanoplasty. The periosteum is exposed and elevated postero-superiorly, creating an anteriorly based flap. Owing to the limitations of the operative field, it is more easily performed if the surgeon alternates position on opposite sides of the operating table. Following flap creation, the procedure is the same as for conventional implantation.
RESULTS: Eight children underwent the modified surgical approach for cochlear implantation between December 2002 and November 2003. The average time taken for the modified operation was no longer than for the conventional method. The surgical trauma of access was no greater than with the traditional approach. All eight patients were admitted for between four and five days. No major complications developed. Subjectively, parents felt that the incisions looked better than what they had expected.
CONCLUSION: In this study, a post-auricular incision for pediatric cochlear implantation gave excellent surgical access and healed well. No major complications were documented and based on the limited numbers involved, the approach did not appear to increase surgical risk. The parents greatly appreciated the reduced cosmetic impact of the approach. The technique proved to be more acceptable than the conventional method cosmetically and psychologically for both the implanted children and their families.

並列關鍵字

post-auricular incision ； cochlear implantation