成人人工耳蜗植入后耳蜗解剖结构在听力保留中的作用：一项系统综述

文献信息

中文摘要

目的： 评估成人人工耳蜗植入术前存在残余听力（RH）者中，耳蜗解剖参数与术后听力保留（HP）之间的关联。
方法： 本系统综述遵循PRISMA指南（PROSPERO：CRD420250630915）。检索了Embase、MEDLINE、PubMed、Scopus和Web of Science中2010年至2026年发表的研究。纳入标准为：年龄≥18岁、术前有残余听力并接受人工耳蜗植入的成人；使用计算机断层扫描或磁共振成像评估耳蜗解剖结构；报告术后6个月内的听力保留；并探讨耳蜗解剖参数与听力保留之间的关系。使用QUIPS工具评估偏倚风险。数据采用叙述性综合；在可能的情况下，使用随机效应模型进行荟萃分析。使用GRADE评估证据确定性。
结果： 共纳入10项研究（487个植入物）。研究参与和混杂因素方面的偏倚风险最高。较长的耳蜗导管长度和较大的耳蜗体积被认为与更好的听力保留相关，但研究结果不一致。六项研究考察了角度插入深度；其中四项进行了合并。荟萃分析显示存在小的正相关（合并r=0.23；p=0.004；95%置信区间：-0.14至0.54），提示插入越深听力保留越差，存在中等异质性（I²=48.5%）。所有结局的证据确定性均评为极低。
结论： 耳蜗解剖结构可能影响人工耳蜗植入后的听力保留，其中较长的耳蜗导管长度和较大的耳蜗体积与良好结局的关联最为一致。然而，证据确定性极低，无法就解剖因素的预测价值得出确切结论。
证据等级： 3。

英文摘要

OBJECTIVE: To evaluate the association between cochlear anatomical parameters and postoperative hearing preservation (HP) following cochlear implantation in adults with preoperative residual hearing (RH).
METHODS: This systematic review followed PRISMA guidelines (PROSPERO: CRD420250630915). Embase, MEDLINE, PubMed, Scopus, and Web of Science were searched for studies published between 2010 and 2026. Eligible studies included adults (≥ 18 years) with preoperative RH undergoing cochlear implantation, assessed cochlear anatomy using computed tomography or magnetic resonance imaging, reported HP within 6 months postoperatively, and examined the relationship between cochlear anatomy parameter(s) and HP. Risk of bias was evaluated using the QUIPS tool. Data were synthesized narratively; where possible, a meta-analysis using a random-effects model was performed. Certainty of evidence was assessed using GRADE.
RESULTS: Ten studies (487 implants) were included. Risk of bias was highest for study participation and confounding. Longer cochlear duct length and larger cochlear volume were suggested to be associated with better HP, though findings were inconsistent. Six studies examined angular insertion depth; four were pooled. Meta-analysis indicated a small positive correlation (pooled r = 0.23; p = 0.004; 95% confidence interval: -0.14 to 0.54), suggesting poorer HP with deeper insertion, with moderate heterogeneity (I 2 = 48.5%). Certainty of evidence for all outcomes was rated very low.
CONCLUSION: Cochlear anatomy may influence hearing preservation following cochlear implantation, with longer cochlear duct length and larger cochlear volume showing the most consistent associations with favorable outcomes. However, the certainty of evidence was very low, precluding firm conclusions regarding the predictive value of anatomical factors.
LEVEL OF EVIDENCE: 3.