通过经卡全线内窥镜方法进行逐步镫骨切除术
Summary
本文旨在为内镜镫骨手术提供一种从手术室设置和患者定位到术后护理的分步方法。这项工作将代表任何愿意用内窥镜经卡技术治疗耳硬化症的耳科医生的指南。
Abstract
近年来，使用内窥镜治疗各种中耳病变（包括耳硬化症）的趋势越来越明显。几项比较传统显微镜和内镜镫骨手术的研究报告了相似的听力结果和总体低并发症发生率。内窥镜在苛刻的镫骨手术环境中已经充分发挥了其潜力，例如椭圆形窗口龛位的不利解剖结构或翻修病例。减少鼓室脊索的操作和低术后味觉障碍的发生率是内镜镫骨手术的进一步益处。
作为一种单手技术，对于新手内镜外科医生来说，治疗假体的出血、定位和压接可能具有挑战性，因此建议在进行内镜镫骨切开术之前进行一些内窥镜耳部手术培训。如果了解正确的器械定位，可以很容易地克服内窥镜和手术器械之间共享手术区域的问题。在耳道狭窄的空间内单手控制出血可能是鼓室 – 肉瓣抬高期间的问题，可能从手术的初步步骤开始就阻碍了外科医生。遵循适当的技术来抬高皮瓣，并与麻醉学团队合作保持低血压，在大多数情况下保证足够的出血控制。
本文的目的是描述经卡内窥镜镫骨切开术的整个外科手术过程，从手术室的设置和患者定位到术后护理。报告了手术操作的分步描述和技术提示，以指导外科医生完成整个过程，并允许任何耳外科医生在内窥镜下进行镫骨手术。
Introduction
自 20 世纪 90 年代首次应用以来，内窥镜在耳部手术中的使用逐渐增加，用于治疗各种中耳病变，包括耳硬化症1。与显微镜相比，内窥镜保证了宽广的曝光区域，高放大倍率和分辨率的图像，减少了骨去除量，并显着改善了手术后的生活质量2，3，4。
一只手的使用被认为是内窥镜技术的局限性，特别是在镫骨手术等功能性手术中5，6。然而，越来越多的论文表明，内镜镫骨手术（EStS）是可行、安全的，并且具有良好的结果，类似于传统的镫骨切开术7，8。此外，内窥镜已经充分发挥了其潜力，特别是在解剖结构不利的患者或翻修病例中，是在这些苛刻的环境中为外科医生提供支持的宝贵工具9，10。对鼓室脊索的有限操作和术后味觉障碍的低发生率是该技术的进一步益处11。
对于在使用内窥镜方面没有太多经验的外科医生来说，EStS可能具有挑战性。如果了解正确的器械处理，可以很容易地克服内窥镜和手术器械之间共享手术区域的问题。在外耳道（EAC）和鼓室狭窄空间内单手控制出血对于新手外科医生来说可能是令人沮丧的12，13。此外，重要的是要正确定位患者并设置手术室，以确保外科医生在整个手术过程中的舒适设置。
本文的目的是展示经卡内膜专用镫镜镫骨切除术的外科手术过程，从手术室的设置和患者定位到术后护理。报告该过程的分步描述，以允许任何耳外科医生理解并可能重现这种干预。
我们报告了一名 56 岁女性因双侧耳硬化而接受右经经管 EStS 治疗的病例。患者报告进展缓慢，双侧听力损失（HL），无眩晕或耳鸣。虽然右耳镜检查正常，但听力测试显示右中度混合HL，术前平均骨传导纯音平均值（BC-PTA）为24 dB，术前平均空气传导纯音平均值（AC-PTA）为71 dB，平均术前空气 – 骨间隙（ABG）为47 dB。鼓室造影为双侧A型，无镬骨反射。认为没有必要进行CT扫描作为术前评估。
Protocol
Representative Results
Discussion
本文提出了一种完全EStS的方案，以指导任何耳科医生在内窥镜下进行镫骨手术。
第一个手术步骤（TMF升高）可能是整个过程中最血腥的阶段，对于外科医生来说，这是一个与单手出血控制相关的挑战13。此外，在耳硬化病例中，鼓膜是完整的;因此，应尽最大努力避免损坏它。正如我们的协议中所报告的那样，可以遵循一些技术提示来减少出血并保证皮瓣的?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
没有。
Materials
| Antifog solution | GOLFF | ||
| Aspirator system (40L/min power) | EXTRUDAN SURGERY APS | 4m long, dimeter ch25 | |
| Cold light source with cable | STORZ | ||
| Consumables: – Iodopovidone solution – Epinephrine – Sterile water to rinse – Spongostan (adsorbable hemostatic sponge) |
ETHICON INC. | ||
| Cotton pads | FARMAC ZABBAN | 10x10cm | |
| Cottonoid pledgets | CODMAN | 10 surgical patties | |
| Endoscope | STORZ | 3mm diameter, 15cm length, 0° | |
| Local anesthetic with vasoconstrictor in sterile and non-sterile syringe | GALENICA SENESE | 10 vials x 5ml | |
| Otologic set instruments | STORZ | round knife, hook, curette, Bellucci scissors and Hartmann forceps, suction tubes | |
| Skeeter Drill | MEDTRONIC | 0.6 mm diamond burr | |
| Stapes prosthesis | SPIGGLE & THEIS | 0.6×4.75mm | |
| Surgical scrub set for otologic patients | EURONDA | ||
| Surgical scrub set for operating surgeon | EURONDA | ||
| Surgical scrub set for nurse | EURONDA | ||
| Vesalius molecular resonance electrosurgical unit | TELEA ELECTRONIC ENGINEERING | ||
| Video equipment: 4K Camera – HD screen – Video processor (Image 1S system) |
STORZ |
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