Wormald P J, Nilssen E L
Department of Otolaryngology, Groote Schuur Hospital, Observatory, Cape Town, South Africa.
Clin Otolaryngol Allied Sci. 1997 Aug;22(4):355-7. doi: 10.1046/j.1365-2273.1997.00026.x.
During mastoid surgery there is a risk to the facial nerve and hearing but at present it is unclear how substantial this risk is. This information is necessary for adequate informed consent to be given, as consent requires information about both the potential risks of the surgery as well as the risks of leaving the disease untreated. The aim of this study is to establish the risks of mastoid surgery and the incidence of complications as a consequence of mastoid disease. The records of all patients undergoing mastoidectomy between 1985 and 1994 were reviewed for preoperative and intra-operative complications. Preoperatively there were 21 (2%) facial nerve palsies, 67 (6.5%) dead ears and 58 (5.7%) intracranial complications of the mastoid disease. If this risk is extrapolated for the population of the Western Cape over a 40-year period (average expected life-span after presentation), the risk of developing a serious complication (facial palsy, dead ear or intracranial) from mastoid disease during this period was 3.8%. The incidence of intra-operative iatrogenic facial nerve palsy was 1.7% (n = 17) and of dead ear was 1.7% (n = 17). Although the comparative risk of developing a severe complication from untreated disease was similar to the risks of surgery (facial palsy, dead ear), the number (58) of intracranial life-threatening preoperative complications presenting in the 10-year period reviewed was significant. These figures provide a base from which otologists can inform patients about the possible risk of mastoid surgery as well as allowing these risks to be compared with the risks of leaving the disease untreated.
在乳突手术过程中，面神经和听力会面临风险，但目前尚不清楚这种风险有多大。对于给予充分的知情同意而言，这些信息是必要的，因为同意需要了解手术的潜在风险以及疾病不治疗的风险。本研究的目的是确定乳突手术的风险以及乳突疾病导致的并发症发生率。回顾了1985年至1994年间所有接受乳突切除术患者的术前和术中并发症记录。术前有21例（2%）面神经麻痹、67例（6.5%）患耳失聪以及58例（5.7%）乳突疾病的颅内并发症。如果将这种风险推算到西开普省40年期间的人口（出现症状后的平均预期寿命），在此期间因乳突疾病发生严重并发症（面神经麻痹、患耳失聪或颅内并发症）的风险为3.8%。术中医源性面神经麻痹的发生率为1.7%（n = 17），患耳失聪的发生率为1.7%（n = 17）。虽然未治疗疾病发生严重并发症的相对风险与手术风险（面神经麻痹、患耳失聪）相似，但在回顾的10年期间出现的58例危及生命的术前颅内并发症数量相当可观。这些数据为耳科医生向患者告知乳突手术可能的风险提供了依据，也能将这些风险与疾病不治疗的风险进行比较。
