CO2雷射使用於鐙骨手術－高雄長庚醫院的經驗

背景：耳硬化症是一種遺傳性的漸進性聽力喪失疾病，常見於歐美白色人種，東方人則相對少見，但其對於國人聽力的影響仍不容輕忽。本研究的主要目的在於分析本院服務的南台灣：(1)二氧化碳雷射鐙骨開窗術是否是安全且低併發症的手術方式；(2)進入中耳腔的方式及使用人工鐙骨的大小對於手術結果的影響；(3)二氧化碳雷射鐙骨開窗術的學習效應分析。方法：利用回溯分析病例的方式，收集自1997年2月至2009年8月，共計31例35耳於本院接受二氣化碳雷射鐙骨手術，並術後追蹤。結果：術前平均氣骨導間距爲31.9dB，術後平均爲15.3dB，其中80%術後氣骨導間距在20dB以內。手術後併發症方面，共5耳(14.3%)發生輕微的併發症，皆於3個月內即恢復正常。另比較經耳道及耳後手術方式及植入不同人工鐙骨種類之術後聽力，統計上均無顯著意義。關於學習效應對手術結果的影響，後期手術的術後平均氣骨導間距及氣導進步值統計上均顯著優於前期手術。結論：關於二氧化碳雷射鐙骨開窗手術併人工鐙骨植入術，以本院的經驗仍是高成功率且相對安全的。後期接受手術之患者，術後聽力進步值統計上顯著優於前期組－可能有與高盛行區類似的學習效應。

關鍵字

二氧化碳雷射；鐙骨開窗術；人工鐙骨；耳硬化症

並列摘要

BACKGROUND: Otosclerosis is a hereditary disease with progressive hearing loss. Though the prevalence in Taiwan is much lower than those in Europe and the U.S., we cannot overlook its effect on hearing and its possible complications caused by stapes surgery. Previous studies suggested CO2 laser-assisted stapes surgery was safe for experienced otolaryngologists in the U.S. However, in southern Taiwan, the safety and result of stapes surgery by inexperienced surgeons remain unclear. In addition, it is open to question how surgical approach, prosthesis type and the learning effect of surgeons affect results of laser-assisted stapes surgery in these areas.METHOD: We reviewed charts of consecutive 35 ears (31 patients) with laser-assisted stapes surgery and followed by two surgeons between the period of February 1997 and August 2009 in Kaohsiung Chang Gung Memorial Hospital. Surgical results were investigated by pre-and post-operative audiometries at frequencies of 0.5, 1, 2 and 4 kHz. We reported the result differences between transcanal and post-auricular approaches and among different prosthesis types. We also categorized all the cases into 17 cases of early operation group and 18 cases of later operation group to investigate the learning effect on surgical results.RESULT: The post-operative air-bone gap (AI3G) averagely improved 16.6 dB from 31.9 dB to 15.3 dB. Eighty percent of post-operative ABGs were within 20 dB. Mild complications occurred in five cases (14.3%) and all recovered within 3 months. There was no significant difference of surgical results between transcanal and postauricular approaches, and among different types of prosthesis. The post-operative hearing improvement in the later operation group was significantly better than that in the early operation group.CONCLUSION: Though otosclerosis prevalence is relatively low and the training opportunities may be less in southern Taiwan, CO2 laser-assisted stapes surgery may still be a successful and safe procedure. Our results suggested there seemed to be a similar learning effect as in high prevalence area on surgical results.

並列關鍵字

CO2 laser ； stapedotomy ； stapes prosthesis ； otosclerosis

國際替代計量

CO2雷射使用於鐙骨手術－高雄長庚醫院的經驗

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