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CT在内耳畸形儿童 术前诊治中的应用

作者:申 玲1 王知祥2

所属单位:1.郑州大学第三附属医院(河南省 妇幼保健院)耳鼻喉科 (河南 郑州 450000) 2.郑州大学第三附属医院(河南省 妇幼保健院)影像科 (河南 郑州 450000)

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摘要

目的 探讨CT在内耳畸形儿童术 前诊治中的应用价值。方法 以2015年1 月-2016年12月我院听力诊断中心诊治的 120例内耳畸形患儿为对象,均行多层螺 旋CT扫描检查,以3名内耳结构正常的儿 童为对照,统计120例内耳畸形患儿CT检 出和分类情况,并分析CT在内耳畸形儿童 术前诊治中的应用价值。结果 120例患儿 经CT扫描检查,共检出内耳畸形235耳, 耳蜗畸形[包含耳蜗未发育(耳蜗结构缺 失)、耳蜗发育不良(耳蜗较小,耳蜗螺旋 ≤1周)]、前庭畸形(前庭扩大亦或与耳蜗 融合组成共同腔)、半规管畸形(半规管细 小、扩大或缺裂)、内听道畸形(内听道狭 窄或扩大)、前庭导水管畸形(前庭导水管 开口呈喇叭状扩大且中段直径>1.5cm)各 56、59、62、22、96例;单一结构畸形共 20耳(8.51%),≥2种畸形共216耳(占比 91.91%);120例内耳畸形患儿中双耳畸形 115例(共230耳),占比95.83%,6例患儿 双侧内耳畸形分类不一致,单耳畸形5例 (共5耳),占比4.17%。结论 CT在内耳畸 形儿童术前诊治中,可清晰显示内耳畸形 分类和畸形程度情况,对提高内耳畸形准 确诊断率及手术方案选择有重要参考价 值。

Objective To investigate the value of CT in the diagnosis and treatment of children with inner ear malformation before surgery. Methods 120 children with inner ear malformation who were admittedto the Hearing DiagnosisCenter of the hospitalfrom January 2015 to December 2016 were selected as subjects, and they were examined by multislice spiral CT scan. Three children with normal inner ear structure were taken as controls. CT detection and classification of 120 children with inner ear malformation were statistically analyzed, and the value of CT in the diagnosis and treatment of children with inner ear malformation was analyzed. Results Of the 120 children examined by CT scan, there were 235 ears with inner ear malformations, and the numbers of cases with cochlear malformations [including cochlear aplasia (cochlear structure deletion), cochlear dysplasia (relatively smaller cochlea, cochlear spiral≤1 cycle)], vestibular malformations (vestibular enlargement or fusion with cochlea forming common cavity), semicircular canal malformations (small, expand or cracked semicircular canal), internal auditory canal malformations (internal auditory canal stenosis or enlargement), vestibular aqueduct malformations (vestibular aqueduct opening being trumpet shaped enlargementand middle diameter> 1.5cm) were 56, 59, 62, 22 and 96, respectively. There were a total of 20 ears (8.51%) with single structural malformations and 216 ears (91.91%) with more than 2 kinds of malformations. There were 115 cases (230 ears) with bilateral ears malformations in the 120 children with inner ear malformations, accounting for 95.83%. 6 children had different types of inner ear malformations. There were 5 cases (5 ears) with monaural malformation, accounting for 4.17%. Conclusion CT can clearly show the classification of inner ear malformation and the degree of malformation in the preoperative diagnosis and treatment of children with inner ear malformations, which is of important reference value for improving the accurate diagnosis rate of inner ear malformation and the selection of surgical plan.

【关键词】内耳畸形;CT;术前诊治;应 用价值

【中图分类号】R764.7+3

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2018.06.020

前言

内耳畸形是儿童感音神经性耳聋的重要病因,流行病学数据显示 新生儿及青少年患病率各约为1‰和6‰,近年来随人工耳蜗植入术不 断发展及其适应症范围逐渐扩大,其已成为内耳畸形患儿重要有效治 疗方案[1-2]。相关研究指出内耳畸形时骨迷路结构深藏在颞骨岩部内且 结构较为精细,实施人工耳蜗植入术前积极评估内耳畸形分类、内耳 畸形的严重程度对手术方案的制定有着重要临床意义[3]。一直以来影 像学技术是内耳畸形的有效诊断手段,其中多层螺旋CT因具有扫描层 厚小、扫描时间短及只需横断面扫描即可获得任一方位影像学图像, 此外其具有强大后处理功能,对内耳空间形态结构可直观立体地显 示,因而被认为在内耳畸形诊断中有一定优势[4],但目前CT在内耳畸 形患儿术前诊治中的应用价值尚无定论,为此笔者于本文展开临床对 照性研究,结果如下。