Xie Yanjun, Sharon Jeffrey D, Pross Seth E, Abt Nicholas B, Varma Sanskriti, Della Santina Charley C, Minor Lloyd B, Carey John P
1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
2 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.
Otolaryngol Head Neck Surg. 2017 Aug;157(2):273-280. doi: 10.1177/0194599817706491. Epub 2017 Jun 27.
Objective To determine the incidence of surgical complications associated with superior canal dehiscence syndrome (SCDS) repair and identify the demographic, medical, and intraoperative risk factors that are associated with SCDS complications. Study Design Cases series with chart review, including patients who underwent SCDS repair between 1996 and 2015. Setting A tertiary care academic medical center. Subjects and Methods Data were collected from 220 patients, including demographic information, medical comorbidities, prior otologic surgical history, surgical approach, intraoperative findings, and postoperative complications. Relative risk analysis and multivariable logistic regression evaluated the associations between perioperative risk factors and SCDS complications. Results A total of 242 consecutive cases were performed: 95.5% middle fossa and 4.5% transmastoid approach (mean age: 47.8 ± 10.6 years; 54.5% female). Surgical complications were reported in 27 (11.2%) cases; 20 (8.3%) had Clavien-Dindo grade I complications, most commonly benign paroxysmal positional vertigo (n = 11, 4.5%) and profound sensorineural hearing loss (n = 6, 2.5%). Two cases (0.8%) had grade II; 4 cases (1.7%), grade III; and 1 case (0.4%), grade IV complications. In the analysis of comorbidities, only preoperative coagulopathy was significantly associated with increased risk of complications (relative risk = 6.4, P < .01). Following multivariate logistic regression adjusting for demographic covariates, coagulopathy was still associated with increased odds of complications (odds ratio = 15.7, P = .03). There were no significant associations between other risk factors and complications. Conclusion SCDS repair has low rates of adverse events. We observed an incidence of 11.2% complications, most commonly postoperative benign paroxysmal positional vertigo. The risk of nonotologic intracranial complications (1.7%) is low.
目的 确定与半规管裂综合征（SCDS）修复相关的手术并发症发生率，并识别与SCDS并发症相关的人口统计学、医学和术中风险因素。研究设计 病例系列研究并进行图表回顾，纳入1996年至2015年间接受SCDS修复的患者。研究地点 一家三级医疗学术医学中心。研究对象与方法 收集了220例患者的数据，包括人口统计学信息、医学合并症、既往耳科手术史、手术入路、术中发现及术后并发症。相对风险分析和多变量逻辑回归评估围手术期风险因素与SCDS并发症之间的关联。结果 共进行了242例连续手术：95.5%采用中颅窝入路，4.5%采用经乳突入路（平均年龄：47.8±10.6岁；54.5%为女性）。27例（11.2%）报告了手术并发症；20例（8.3%）发生Clavien-Dindo I级并发症，最常见的是良性阵发性位置性眩晕（n = 11，4.5%）和重度感音神经性听力损失（n = 6，2.5%）。2例（0.8%）为II级；4例（1.7%）为III级；1例（0.4%）为IV级并发症。在合并症分析中，仅术前凝血功能障碍与并发症风险增加显著相关（相对风险 = 6.4，P <.01）。在对人口统计学协变量进行多变量逻辑回归调整后，凝血功能障碍仍与并发症几率增加相关（优势比 = 15.7，P =.03）。其他风险因素与并发症之间无显著关联。结论 SCDS修复的不良事件发生率较低。我们观察到并发症发生率为11.2%，最常见的是术后良性阵发性位置性眩晕。非耳科颅内并发症的风险（1.7%）较低。
