ハンドピース型CO2レーザーを使用したアブミ骨手術の検討

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Small-fenestra stapedotomy (SFS) is generally regarded as a first-choice procedure in terms of minimizing postoperative dizziness and improving hearing levels. However, otosclerotic changes to the footplate are relatively mild in most Japanese patients. The CO2 laser has been widely used for management of the nasal mucosa in Japan. This study examined whether the CO2 laser could cut the crus bones to keep the footplate in place. This study evaluated data from 63 patients who had undergone stapes surgery with the CO2 laser between October 2010 and December 2013. A transcanal approach was adopted under general anesthesia. The stapes tendon and posterior crus were cut with the CO2 laser. The anterior crus was cut with the laser or was fractured. A SkeeterTM drill or CO2 laser was used to open the stapes footplate, and a piston was then inserted. SFS was performed in 50 patients (79%), partial stapedectomy in 9 (14%) and total stapedectomy in 4 (6%). Between 1999 and 2009, SFS was performed in 54 of 97 patients (56%), partial stapedectomy in 26 (27%), and total stapedectomy in 17 (18%). The postoperative air-bone gap was ≤10 dB in 33 cases (79%), 11-20 dB in 8 cases (19%), and >30 dB in 1 case. The rate of stapedotomy was significantly increased compared with the procedure without using a CO2 laser. Therefore, these results suggest that a CO2 laser can be used to cut the stapes crus during stapedotomy.
耳鼻咽喉科臨床学会の論文

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