【摘要】：目的:分析報(bào)告人工耳蝸植入后植入體周?chē)ぐ甑南嚓P(guān)并發(fā)癥,包括植入體周?chē)难[、植入體周?chē)难迥[、植入體周?chē)哪撃[、皮瓣感染、皮瓣壞死以及傷口感染等,以探討這些并發(fā)癥發(fā)生的可能原因、相應(yīng)的處理措施和相關(guān)影響因素。方法和材料:回顧分析于2005年~2015年在安徽醫(yī)科大學(xué)第一附屬醫(yī)院耳鼻咽喉科接受人工耳蝸植入手術(shù)的1500例患者,發(fā)生與植入體周?chē)ぐ甑南嚓P(guān)并發(fā)癥的病例的共有42例,其中成人6例,兒童36例。結(jié)果:由同一位手術(shù)醫(yī)師完成的1500例人工耳蝸植入患者中,發(fā)生植入體周?chē)[的有20例,經(jīng)過(guò)穿刺抽液、頭部壓力敷料加壓包扎后,全部痊愈;出現(xiàn)植入體周?chē)难迥[的共有15例,在經(jīng)過(guò)穿刺引流2周、使用有效抗生素及局部壓力敷料加壓包扎后,其中10例患者基本恢復(fù),但有5例最終發(fā)展為皮瓣壞死,并進(jìn)行患側(cè)人工耳蝸裝置取出及對(duì)側(cè)人工耳蝸重新植入;4例患者出現(xiàn)植入體周?chē)撃[,在使用慶大霉素局部灌注和有效抗生素靜脈滴注后,其中2名患者于穿刺抽膿2周后恢復(fù),另2名患者最終出現(xiàn)皮瓣壞死,最終接受患側(cè)人工耳蝸裝置取出及對(duì)側(cè)人工耳蝸再植入;1名患者出現(xiàn)切口感染,經(jīng)過(guò)清創(chuàng)縫合后,患者痊愈出院。成人及兒童術(shù)后輕型及重型并發(fā)癥在統(tǒng)計(jì)學(xué)上無(wú)顯著差異(P=0.567)。結(jié)論:植入體周?chē)ぐ暝缙诓l(fā)癥與手術(shù)的技巧有一定關(guān)系,可以通過(guò)不斷總結(jié)經(jīng)驗(yàn)來(lái)減少其發(fā)生。晚期并發(fā)癥,特別是植入體周?chē)难迥[,原因不明,有的數(shù)年后在無(wú)明顯原因及誘因下發(fā)生,可能與過(guò)敏反應(yīng)有關(guān)。在經(jīng)過(guò)我們抗炎、抗過(guò)敏、局部加壓包扎及穿刺治療無(wú)效后,只能選擇患側(cè)人工耳蝸取出及重新植入。無(wú)論成人或是兒童,皮瓣相關(guān)并發(fā)癥發(fā)生率無(wú)明顯統(tǒng)計(jì)學(xué)上的差異,此外,植入體周?chē)迥[的原因仍有待進(jìn)一步研究,這也是我們未來(lái)研究的目標(biāo)。
[Abstract]:Objective: to report the complications of the skin flap around the implant after cochlear implantation, including hematoma around the implant, seroma around the implant, abscess around the implant, skin flap infection, skin flap necrosis and wound infection, etc. In order to explore the possible causes of these complications, corresponding management measures and related factors. Methods and materials: 1500 patients who underwent cochlear implantation in the department of otorhinolaryngology, the first affiliated hospital of Anhui Medical University from 2005 to 2015 were retrospectively analyzed. There were 6 adults and 36 children. Results: of the 1500 patients with cochlear implant performed by the same surgeon, 20 cases had hematoma around the implant. After puncture and pressure dressing, all cases were cured. A total of 15 patients had seroma around the implant. After 2 weeks of puncture and drainage, 10 of them recovered with effective antibiotics and local pressure dressing, but 5 eventually developed skin flap necrosis, and 5 of them developed skin flap necrosis after 2 weeks of puncture and drainage with effective antibiotics and local pressure dressing. The affected side cochlear implant was removed and the contralateral cochlear implant was reimplanted. After administration of gentamicin and effective antibiotics intravenously, 2 patients recovered 2 weeks after aspiration of pus, and the other 2 cases finally developed skin flap necrosis, and 4 cases had periimplant abscess after injection of gentamicin and effective antibiotics intravenously, and the other 2 cases finally developed skin flap necrosis. Finally, the affected side cochlear implant was removed and the contralateral cochlear implant was reimplanted. One patient developed incisional infection. After debridement and suture, the patient recovered and was discharged from hospital. There was no significant difference in mild and severe complications between adults and children (P < 0. 567). Conclusion: the early complications of the periimplant flap are related to the skill of operation, which can be reduced by summing up the experience. The late complications, especially the seroma around the implant, are unknown, and some of them occur after several years without obvious cause or inducement, which may be related to allergic reaction. After our anti-inflammatory, anti-allergic, local pressure bandaging and puncture treatment is ineffective, only the affected side cochlear removal and re-implantation. There is no significant difference in the incidence of skin flap-related complications between adults and children. In addition, the cause of periimplant seroma remains to be further studied, which is also the goal of our future study.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R764.9

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相關(guān)期刊論文 前5條

1 戴樸;蔣刈;高松;;微創(chuàng)人工耳蝸植入[J];中國(guó)耳鼻咽喉顱底外科雜志;2016年05期

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本文編號(hào)：2471934