内镜在迷路后进路手术中的应用
发布时间：2018-11-26 06:48
【摘要】：目的探讨内镜在迷路后进路手术中的临床应用价值。方法回顾性分析2010年1月至2016年1月收治的32例侧颅底患者的临床病例资料,男19例,女13例,年龄35-69岁,其中颅神经疾病27例(梅尼埃病20例,面肌痉挛5例,三叉神经痛2例),桥小脑角胆脂瘤3例,听神经瘤2例。所有病例均采用内镜辅助下迷路后进路完成,术后均随访1~5年,对手术效果进行分析。结果 27例颅神经病变患者术后症状均消失,其中20例梅尼埃患者行前庭神经切断术,术后眩晕控制率100%;5例面肌痉挛患者行面神经微血管减压术,术后面部痉挛症状完全缓解;2例三叉神经痛患者行三叉神经微血管减压术,术后疼痛症状消失。以上27例颅神经病变患者的术后面神经功能良好,所有病例听力与术前相比均无明显下降,无并发症,随访1-5年,无复发。3例桥小脑角胆脂瘤患者,胆脂瘤均彻底切除,术后无一例出现面神经麻痹或其他颅脑并发症,术后1例患者出现听力丧失,2例保存实用听力,随访1-5年,胆脂瘤无复发。2例听神经瘤患者肿瘤均全切除,术后均保存实用听力,无一例出现面神经麻痹或其他颅脑并发症,随访1-5年,肿瘤无复发。结论内镜辅助的迷路后进路,在功能性颅神经手术中具有良好的应用价值,能够清晰显露责任血管和V~XI颅神经,手术效果好;在桥小脑角胆脂瘤及听神经瘤手术中,内镜可以多角度无死角地观察,并做到微创全切除病变。
[Abstract]:Objective to evaluate the clinical value of endoscopy in posterior labyrinthine approach. Methods the clinical data of 32 patients with lateral skull base admitted from January 2010 to January 2016 were retrospectively analyzed. There were 19 males and 13 females aged 35-69 years. Among them, 27 cases were cranial neuropathy (Meniere's disease 20 cases, hemifacial spasm 5 cases). Trigeminal neuralgia (n = 2), cholesteatoma of cerebellopontine angle (n = 3) and acoustic neuroma (n = 2). All cases were treated by endoscope assisted posterior labyrinthine approach. All patients were followed up for 1 ~ 5 years. Results the symptoms of 27 patients with cranial neuropathy disappeared after operation. Twenty patients with Meniere underwent vestibular neurotomy, and the control rate of vertigo was 100%. Facial microvascular decompression was performed in 5 patients with hemifacial spasm, and the symptoms of facial spasm were completely relieved in 2 patients with trigeminal neuralgia. The facial nerve function of 27 patients with craniocerebral neuropathy was good after operation. The hearing of all the patients had no significant decrease and no complications. The follow-up for 1-5 years showed no recurrence. 3 cases of cholesteatoma of cerebellopontine angle were completely resected from cholesteatoma. No facial nerve palsy or other craniocerebral complications occurred after operation, 1 patient had hearing loss, 2 patients had practical hearing preservation, and there was no recurrence of cholesteatoma after follow-up for 1 to 5 years. The tumors of 2 patients with acoustic neuroma were completely resected. No facial paralysis or other craniocerebral complications were found in all cases, and no recurrence was found during the follow-up period of 1 to 5 years. Conclusion Endoscope-assisted posterior labyrinthine approach has good application value in functional cranial nerve surgery and can clearly expose the responsible blood vessel and V~XI cranial nerve. In the operation of cholesteatoma and acoustic neuroma of cerebellopontine angle, endoscopy can be observed in multiple angles without dead angle, and minimally invasive total excision of lesions is achieved.
【作者单位】： 郑州大学第一附属医院耳科;上海交通医学院附属第九人民医院耳鼻咽喉头颈外科;上海交通大学医学院耳科研究所;上海耳鼻疾病转化医学重点实验室;
【基金】：国家自然科学基金面上项目(81470681,81570906,81670919,82371086)~~
【分类号】：R764.9
，
本文编号：2357636
[Abstract]:Objective to evaluate the clinical value of endoscopy in posterior labyrinthine approach. Methods the clinical data of 32 patients with lateral skull base admitted from January 2010 to January 2016 were retrospectively analyzed. There were 19 males and 13 females aged 35-69 years. Among them, 27 cases were cranial neuropathy (Meniere's disease 20 cases, hemifacial spasm 5 cases). Trigeminal neuralgia (n = 2), cholesteatoma of cerebellopontine angle (n = 3) and acoustic neuroma (n = 2). All cases were treated by endoscope assisted posterior labyrinthine approach. All patients were followed up for 1 ~ 5 years. Results the symptoms of 27 patients with cranial neuropathy disappeared after operation. Twenty patients with Meniere underwent vestibular neurotomy, and the control rate of vertigo was 100%. Facial microvascular decompression was performed in 5 patients with hemifacial spasm, and the symptoms of facial spasm were completely relieved in 2 patients with trigeminal neuralgia. The facial nerve function of 27 patients with craniocerebral neuropathy was good after operation. The hearing of all the patients had no significant decrease and no complications. The follow-up for 1-5 years showed no recurrence. 3 cases of cholesteatoma of cerebellopontine angle were completely resected from cholesteatoma. No facial nerve palsy or other craniocerebral complications occurred after operation, 1 patient had hearing loss, 2 patients had practical hearing preservation, and there was no recurrence of cholesteatoma after follow-up for 1 to 5 years. The tumors of 2 patients with acoustic neuroma were completely resected. No facial paralysis or other craniocerebral complications were found in all cases, and no recurrence was found during the follow-up period of 1 to 5 years. Conclusion Endoscope-assisted posterior labyrinthine approach has good application value in functional cranial nerve surgery and can clearly expose the responsible blood vessel and V~XI cranial nerve. In the operation of cholesteatoma and acoustic neuroma of cerebellopontine angle, endoscopy can be observed in multiple angles without dead angle, and minimally invasive total excision of lesions is achieved.
【作者单位】： 郑州大学第一附属医院耳科;上海交通医学院附属第九人民医院耳鼻咽喉头颈外科;上海交通大学医学院耳科研究所;上海耳鼻疾病转化医学重点实验室;
【基金】：国家自然科学基金面上项目(81470681,81570906,81670919,82371086)~~
【分类号】：R764.9
，
本文编号：2357636
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