CAJ | 학술논문

目的探讨虚拟CT耳镜对单纯性中耳畸形的术前评估并依其分型选择合适的手术进路.方法对21例(23耳)单纯性中耳畸形患者行颞骨CT三维重建技术—虚拟CT耳镜观察,依听骨链畸形程度将中耳畸形分为三型.A型(上半部畸形)和C型(全听骨链畸形)经耳后切口行保留完整外耳道后壁的上鼓室进路鼓室探查术;B型(下半部畸形)经耳道内进路行传统的鼓室探查术.结果21例(23耳)中耳畸形,虚拟CT耳镜发现9耳为A型,5耳C型,经完壁式上鼓室进路行听骨链松解术或听骨链成形术;9耳为B型,经耳道内进路完成前庭窗开窗与人工镫骨手术.23耳术后外耳道和鼓膜均保存或恢复完好,语频听力平均提高15~35 dB.手术探查听骨链畸形与术前虚拟CT耳镜观察基本符合.结论虚拟CT耳镜能为单纯性中耳畸形听骨链病变提供清晰的三维立体图像,有助于选择手术进路.
목적탐토허의CT이경대단순성중이기형적술전평고병의기분형선택합괄적수술진로.방법대21례(23이)단순성중이기형환자행섭골CT삼유중건기술—허의CT이경관찰,의은골련기형정도장중이기형분위삼형.A형(상반부기형)화C형(전은골련기형)경이후절구행보류완정외이도후벽적상고실진로고실탐사술;B형(하반부기형)경이도내진로행전통적고실탐사술.결과21례(23이)중이기형,허의CT이경발현9이위A형,5이C형,경완벽식상고실진로행은골련송해술혹은골련성형술;9이위B형,경이도내진로완성전정창개창여인공등골수술.23이술후외이도화고막균보존혹회복완호,어빈은력평균제고15~35 dB.수술탐사은골련기형여술전허의CT이경관찰기본부합.결론허의CT이경능위단순성중이기형은골련병변제공청석적삼유입체도상,유조우선택수술진로.
Objective To investigate the value of preoperative virtual CT endoscopy in evaluation of congenital mid?dle ear malformations and selection of surgical approach. Methods High resolution CT scanning was conducted in 21 pa?tients (23ears) with congenital middle ear malformations to collect original image data focused on the middle ear, followed by 3-dimensional reconstruction to evaluate ossicular chain disorders. Middle ear malformations were classified into three types based on the degree of ossicular deformity. A retroauricular attic approach with ear canal wall preservation was select?ed for types A and C malformations, and traditional exploratory tympanotomy via an ear canal incision was selected for type B malformations. Results Virtual CT endoscopy showed type A malformations in 9 ears, type C malformations in 5 ears, and type B malformations in 9 ears were, which were treated with vestibular window fenestration and artificial stapes prostheses. Reconstructed external auditory canal and tympanic membrane remained intact postoperatively in 23 ears, with an average of 15 to 35 dB speech frequency hearing improvement. Preoperative Virtual CT endoscopy results were basically consistent with surgical exploration findings.Conclusions Virtual CT endoscopy provides important reference data for preoperative evaluation in congenital middle ear malformations. Selection of surgical approach can be based upon the type of congenital middle ear malformations revealed by virtual CT endoscopy.