不同方式半规管阻塞术治疗顽固性梅尼埃病疗效分析

发布时间：2019-01-10 08:45

【摘要】：目的通过不同方式半规管阻塞术治疗顽固性梅尼埃病的临床观察及疗效分析,对比分析不同阻塞方法对眩晕的控制及听力保留率,为梅尼埃病的个体化最佳治疗方案的选择提供依据。方法回顾性分析2010年12月至2016年1月我院328例行半规管阻塞术的梅尼埃病患者的临床资料。参照梅尼埃病的诊断依据和疗效评估(2006年,贵阳)标准,所有患者均临床诊断为单侧梅尼埃病,行规范化药物保守治疗至少1年以上,但眩晕仍反复发作。其中三个半规管阻塞术302例,两个半规管阻塞术21例,包括水平半规管联合后半规管阻塞15例,水平半规管联合上半规管阻塞6例;一个半规管阻塞术5例,均为水平半规管阻塞。采用纯音测听、前庭双温试验和颈源性前庭诱发肌源性电位(cervical vestibular evokedmyogenic potential,c VEMP)进行听力学和前庭功能评估,通过内耳MRI膜迷路水成像观察阻塞术后膜迷路的形态学改变。结果三个半规管阻塞术对眩晕控制的总有效率为98.0%(296/302),A级81.8%(247/302),B级16.2%(49/302),听力保留率70.2%(212/302);两个半规管阻塞术对眩晕控制的总有效率为85.7%(18/21),A级61.9%(13/21),B级23.8%(5/21),听力保留率76.2%(16/21);一个半规管阻塞对眩晕控制的总有效率为60.0%(3/5),A级40.0%(2/5),B级20.0%(1/5),听力保留率80.0%(4/5)。三个半规管阻塞术眩晕控制有效率高于两个半规管阻塞或一个半规管阻塞术(P0.05)。听力保留率三组之间无明显差异(P0.05)。结论半规管阻塞术是治疗顽固性梅尼埃病的有效方法。三个半规管阻塞术眩晕控制有效率最高。
[Abstract]:Objective to analyze the clinical observation and curative effect of different methods of semicircular canal occlusion in the treatment of refractory Meniere's disease, and to compare the control of dizziness and the rate of hearing retention with different methods of obstruction. To provide the basis for the selection of the best individualized treatment for Meniere's disease. Methods the clinical data of 328 patients with Meniere's disease undergoing semicircular canal occlusion from December 2010 to January 2016 were retrospectively analyzed. According to the criteria of diagnosis and curative effect evaluation of Meniere's disease (2006, Guiyang), all the patients were diagnosed as unilateral Meniere's disease clinically and treated with standardized medicine conservative therapy for at least one year, but the vertigo still recurred repeatedly. Three semicircular canal occlusion in 302 cases, two semicircular canal occlusion in 21 cases, including horizontal semicircular canal combined with posterior semicircular canal occlusion in 15 cases, horizontal semicircular canal combined with upper semicircular canal obstruction in 6 cases. There were 5 cases of semicircular canal obstruction, all of which were horizontal semicircular canal obstruction. Pure tone audiometry, vestibular double temperature test and cervical vestibular evoked myogenic potential (cervical vestibular evokedmyogenic potential,c VEMP) were used to evaluate audiology and vestibular function. Morphological changes of membranous labyrinth after occlusion were observed by MRI membrane labyrinth water imaging of inner ear. Results the total effective rate of three semicircular canal occlusion for vertigo control was 98.0% (296 / 302), A, 81.8%) (247 / 302), B 16.2%, 49 / 302), and the hearing retention rate was 70.2% (212 / 302). The total effective rate of two semicircular canal occlusion for controlling vertigo was 85.7% (18 / 21), A, 61.9%, 13 / 21), B, 23.8%, 5 / 21), and the hearing retention rate was 76.2% (16 / 21). The total effective rate of semicircular canal obstruction for vertigo control was 60.0% (3 / 5), A 40.0%) (2 / 5), B 20.0% (1 / 5), and the hearing retention rate was 80.0% (4 / 5). The vertigo control efficiency of three semicircular canal occlusion was higher than that of two semicircular canal occlusion or semicircular canal occlusion (P0.05). There was no significant difference in hearing retention rate among the three groups (P0.05). Conclusion semicircular canal occlusion is an effective method for the treatment of refractory Meniere disease. Three semicircular canaliculi occlusion of vertigo control efficiency is the highest.
【作者单位】：山东大学附属省立医院耳鼻咽喉头颈外科山东省立医院集团眼耳鼻喉医院耳鼻咽喉头颈外科山东省听力重建重点实验室;
【基金】：国家自然科学基金(81200744) 山东省科技发展计划项目(2011GGH21839)~~
【分类号】：R764.9

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