中耳手术中鼓索神经的保护与效果分析

发布时间：2018-05-31 01:07

本文选题：中耳手术 + 鼓索神经　；参考：《听力学及言语疾病杂志》2017年04期

【摘要】：目的探讨中耳手术中鼓索神经的处理方法及保护鼓索神经的可行性和必要性。方法以2013年9月~2016年3月行中耳手术的155例(155耳)患者为研究对象,男86例,女69例,年龄19~65岁,平均38.23±5.7岁;其中,鼓室成形术I型24例,上鼓室切开+鼓室成形术I型6例,上鼓室切开+鼓室成形术II型22例,完壁式乳突切开+鼓室成形术23例,开放式乳突切开+鼓室成形术74例,镫骨底板钻孔+活塞人工镫骨植入术6例,均记录手术中鼓索神经显露和保护的方法,并观察患者术后3天和术后1月时同侧舌的味觉。结果 155例中,12例术中未暴露鼓索神经,126例术中完整保留之,故鼓索神经保存率为89.03%(138/155),鼓索损伤的17例中15例(88.2%,15/17)术后3天和术后1月时舌味觉减退;鼓索神经保护完整的126例中13例(10.3%,13/126)术后3天味觉减退,均于术后1个月内自行恢复;1例在术后16天发生迟发性面瘫,经糖皮质激素治疗2周后完全恢复。在鼓索神经保护完整与术中鼓索神经断裂这两部分病例间术后3天和术后1个月时味觉异常发生率差异均有统计学意义(χ~2=57.753,P=0.000;χ~2=124.2,P=0.000)。结论根据鼓索神经的走行位置和显露方式不同,在中耳手术中采取个体化的措施保护鼓索神经是可行的,可使患者术后味觉功能保持良好。
[Abstract]:Objective to explore the treatment of chordal tympanic nerve in middle ear operation and the feasibility and necessity of protecting chordal tympanic nerve. Methods from September 2013 to March 2016, 155 patients (86 males and 69 females, aged 1965 years, mean 38.23 卤5.7 years) underwent middle ear surgery, including 24 cases of tympanoplasty type I and 6 cases of tympanoplasty type I. Tympanoplasty II, tympanoplasty, tymp@@ Methods of exposure and protection of chorda tympani nerve were recorded and taste sensation of ipsilateral tongue was observed 3 days after operation and 1 month after operation. Results among 155 cases, 12 cases were not exposed to chorda tympani nerve during operation, 126 cases were preserved completely during operation, so the preservation rate of tympanic cord nerve was 89.03 / 155%, 15 out of 17 cases of tympanic cord injury were 88.2% 15 / 17) 3 days after operation and 1 month after operation, the taste and tongue of tongue decreased. Of 126 cases with intact protection of the chorda tympani nerve, 13 cases (10.3% 13 / 126) suffered from loss of taste 3 days after operation. All of them recovered spontaneously within one month after operation. One case developed delayed facial paralysis 16 days after operation and recovered completely after 2 weeks of glucocorticoid treatment. There were statistically significant differences in the incidence of abnormal taste between the two groups at 3 days after operation and 1 month after operation (蠂 2: 57.753, P = 0.000; 蠂 ~ 2, 124.2U, P = 0.000), and the difference was significant between the two groups (蠂 ~ 2, P = 57.753, P = 0.000, P = 0.000, P = 0.000, P = 0.000, P = 0.000). Conclusion it is feasible to take individualized measures to protect the chordal tympanic nerve during middle ear operation according to the location and exposure of the chorda tympani nerve, which can keep the taste function of the patients good after operation.
【作者单位】：南方医科大学珠江医院耳鼻咽喉科;佛山市第一人民医院耳科;
【分类号】：R764.9

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