目的 分析12月龄以下婴儿人工耳蜗植入的可行性和相关手术技巧.方法 14例12月龄以下婴儿及63例13～24月龄幼儿在上海交通大学附属新华医院耳鼻咽喉头颈外科植入单侧人工耳蜗.记录分析内容分为两部分,手术相关部分包括手术时间、术中出血量、住院时间、手术并发症,听力学部分包括声场啭音听阈、听力表现指数、言语发育商、咿呀学语发生及爆发月龄.结果 婴儿组与幼儿组的住院时间((-x)±s,下同)分别为(5.1±0.5)d和(5.8±1.1)d,差异有统计学意义(t=-3.17,P<0.05);术后并发症发生率分别为7.1%(1/14)和11.1%(7/63),差异无统计学意义(x2=0.19,P<0.05);手术时间、术中出血量差异无统计学意义(t值分别为1.55和-0.86,P值均<0.05).随访时间12～24个月,随访期间,两组患儿声场啭音听阈、言语发育商均有提高,但差异无统计学意义(t值分别为4.6和3.8,P值均<0.05).80%(8/10)婴儿在术后24个月听力表现指数达到6～7分,且咿呀学语发生在(14.1 ±0.9)月龄,明显优于幼儿组的(22.6±3.0)月龄.结论 12月龄以下婴儿人工耳蜗植入具有可行性,可缩短患儿听力剥夺时间,但其手术技巧和经验要求较高,建议有经验的耳科医师有选择地谨慎开展这一领域的研究.%Objective To explore feasibility and surgical highlight of cochlear implantation in infants under 12 months of age. Methods A retrospective review was performed in 14 infants under 12 months of age and 63 cases from 13 to 24 months of age with bilateral profound sensorineural hearing loss,who underwent unilateral cochlear implantation surgery. The operative parameters, including operation duration, amount of intraoperative bleeding, length of hospital stay, surgical complications and auditory outcomes, including warble tone average aided in free field, category of auditory performance (CAP) ,language behavior development quotient, babbling onset or spurt were recorded. Results There was no significant difference between infants younger than 12 months and older in operation duration, amount of intraoperative bleeding, except for the length of hospital stay. Otherwise, less complication occurred in younger group (7. 1% and 11.1%, respectively, x2 =0. 19, P >0.05). The surgical highlights and experience, strictly restricted operation duration, intimate cooperation among the treatment team members and reduction of intraoperative bleeding are key points to ensure safety and success of the operation. The warble tone average aided in free field and language behavior developmental quotient of younger infants were both improved during follow-up and showed no significant difference compared with older group( t =4.6 and 3.8 ,P > 0.05 ). 80% of infants who finished 24 months follow-up had a CAP score of 6 or 7. The babbling onset in younger group occurred at (14.1 ± 0. 9) months of life, which was better than that in older group [(22.6 ± 3.0) months of life]. Conclusions It is feasible to put cochlear implantation in infants under 12 months of age. And the earlier cochlear implantation could shorten auditory deprivation for children with bilateral congenital profound sensorineural hearing loss. Considering the high requirement of surgical highlights and experience, the suggest was that only experienced otologists challenge this domain cautiously.
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