耳蜗植入体周围皮瓣的相关并发症研究
发布时间：2019-05-08 13:04
【摘要】：目的:分析报告人工耳蜗植入后植入体周围皮瓣的相关并发症,包括植入体周围的血肿、植入体周围的血清肿、植入体周围的脓肿、皮瓣感染、皮瓣坏死以及伤口感染等,以探讨这些并发症发生的可能原因、相应的处理措施和相关影响因素。方法和材料:回顾分析于2005年~2015年在安徽医科大学第一附属医院耳鼻咽喉科接受人工耳蜗植入手术的1500例患者,发生与植入体周围皮瓣的相关并发症的病例的共有42例,其中成人6例,儿童36例。结果:由同一位手术医师完成的1500例人工耳蜗植入患者中,发生植入体周围血肿的有20例,经过穿刺抽液、头部压力敷料加压包扎后,全部痊愈;出现植入体周围的血清肿的共有15例,在经过穿刺引流2周、使用有效抗生素及局部压力敷料加压包扎后,其中10例患者基本恢复,但有5例最终发展为皮瓣坏死,并进行患侧人工耳蜗装置取出及对侧人工耳蜗重新植入;4例患者出现植入体周围脓肿,在使用庆大霉素局部灌注和有效抗生素静脉滴注后,其中2名患者于穿刺抽脓2周后恢复,另2名患者最终出现皮瓣坏死,最终接受患侧人工耳蜗装置取出及对侧人工耳蜗再植入;1名患者出现切口感染,经过清创缝合后,患者痊愈出院。成人及儿童术后轻型及重型并发症在统计学上无显著差异(P=0.567)。结论:植入体周围皮瓣早期并发症与手术的技巧有一定关系,可以通过不断总结经验来减少其发生。晚期并发症,特别是植入体周围的血清肿,原因不明,有的数年后在无明显原因及诱因下发生,可能与过敏反应有关。在经过我们抗炎、抗过敏、局部加压包扎及穿刺治疗无效后,只能选择患侧人工耳蜗取出及重新植入。无论成人或是儿童,皮瓣相关并发症发生率无明显统计学上的差异,此外,植入体周围血清肿的原因仍有待进一步研究,这也是我们未来研究的目标。
[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.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.9
[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.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.9
【参考文献】
相关期刊论文 前5条
1 戴朴;蒋刈;高松;;微创人工耳蜗植入[J];中国耳鼻咽喉颅底外科杂志;2016年05期
2 吕铁军;韩志乐;李章剑;崔崤\，
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