CAJ | 학술논문

　　目的通过总结31例再次人工耳蜗植入术中所发现的问题，总结经验并探讨再次耳蜗植入的注意事项方法分析2005年3月～2012年12月北京大学人民医院31例行再次人工耳蜗植入患者手术中出现的问题。结果31例患者均顺利完成人工耳蜗再植入，再次植入的原因不同，其中外伤（13例）、中耳乳突炎（2例）、产品更新换代（1例）、其他不明原因的（15例）。术中发现植入体周围骨质包裹的(11例)，植入体周围炎性反应（4例），乳突骨化的（5例），伴有中耳乳突炎的（4例），面神经隐窝软组织阻塞的（9例），耳蜗开窗口小，需要扩大开窗的（4例）。术后伤口延迟愈合的（3例）。结论植入体周围的炎症反应、中耳乳突炎、耳蜗开窗周围纤维结缔组织增生等会加大再次耳蜗植入手术难度，首次手术时应尽量避免能引起此类问题的操作，如胶、丝线、肌肉或颞肌筋膜固定电极等。同时中耳乳突炎可能是导致二次手术的一个较重要原因，应尽量预防。
　　목적통과총결31례재차인공이와식입술중소발현적문제，총결경험병탐토재차이와식입적주의사항방법분석2005년3월～2012년12월북경대학인민의원31례행재차인공이와식입환자수술중출현적문제。결과31례환자균순리완성인공이와재식입，재차식입적원인불동，기중외상（13례）、중이유돌염（2례）、산품경신환대（1례）、기타불명원인적（15례）。술중발현식입체주위골질포과적(11례)，식입체주위염성반응（4례），유돌골화적（5례），반유중이유돌염적（4례），면신경은와연조직조새적（9례），이와개창구소，수요확대개창적（4례）。술후상구연지유합적（3례）。결론식입체주위적염증반응、중이유돌염、이와개창주위섬유결체조직증생등회가대재차이와식입수술난도，수차수술시응진량피면능인기차류문제적조작，여효、사선、기육혹섭기근막고정전겁등。동시중이유돌염가능시도치이차수술적일개교중요원인，응진량예방。
Objectives To report surgical findings in 31 cases of revision cochlear implantation. Method This is a de-scriptive retrospective review of 31 cases of revision cochlear implantation carried out at our department during the period be-tween 2005 and 2012. Results In all cases, electrodes were successfully and totally inserted into the cochlea. The cause for re-vision varied and included trauma (13 cases), otitis media and mastoiditis (2 cases), technological update (1 case), and un-known causes (15 cases). Surgical findings included ossification surrounding the implant (11 cases), fibrosis around the im-plant (4 cases), mastoidectomy reossification (5 cases),otitis media and mastoiditis (4 cases), soft tissue blocking the facial re-cess (9 cases), cochleostomy stenosis (4 cases) and delayed wound healing (3 cases). Conclusions Fibrosis around the im-plant, soft tissue blocking the facial recess and otitis media and mastoiditis can increase the difficulty of operation. In the pri-mary surgery, maneuvers that may lead to such problems should be avoided.