完壁式鼓室成形术中面神经监测的临床应用

发布时间：2018-01-30 03:08

本文关键词： 完壁式鼓室成形术面神经监测　出处：《中华耳科学杂志》2014年04期 　论文类型：期刊论文

【摘要】：目的探讨面神经监测仪在完壁式鼓室成形术中的应用价值。方法在面神经监测下完成完壁式鼓室成形术21例,术中在解剖定位的基础上用面神经监测仪确认面神经的走行,尤其经面隐窝进路开放后鼓室过程中实时监测预防损伤面神经,记录开放前后刺激阈值。结果术中发现面神经前移1例。完成完壁式手术的21例患者中,面隐窝进路开放后鼓室前面神经乳突段刺激阈值为0.38~0.90m A,平均(0.66±0.16)m A,开放后面神经乳突段刺激阈值为0.16~0.43m A,平均(0.32±0.09)m A。经配对t检验,差异有统计学意义(p0.05)。术中发现面神经骨管缺损4例。术后无一例患者出现即发性或迟发性面瘫。术后半年全部干耳。结论面神经监测仪能在完壁式鼓室成形术中有效识别面神经,有助于扩大面隐窝的开放范围、彻底清除病灶而不增加面神经损伤的机会。
[Abstract]:Objective to investigate the application value of facial nerve monitor in wall tympanoplasty. Methods 21 cases of wall tympanoplasty were performed under facial nerve monitoring. The facial nerve was confirmed by facial nerve monitor on the basis of anatomical localization during the operation, especially in the process of real-time monitoring and preventing the injury of the facial nerve after the tympanum was opened through the approach of facial recess. Results the facial nerve was moved forward in 1 case during the operation, and 21 cases completed the wall operation. The stimulation threshold of anterior tympanic nerve and mastoid process was 0.38 卤0.90 Ma, with an average of 0.66 卤0.16 Ma. After opening, the stimulation threshold of the mastoid segment of the facial nerve was 0.16 卤0.43 Ma, with an average of 0.32 卤0.09 Ma. The difference was statistically significant (p0.05). 4 cases of facial nerve bone canal defect were found during operation, none of them had immediate or delayed facial paralysis after operation, and all dry ears were found half a year after operation. Conclusion facial nerve monitor can effectively identify facial nerve in tympanoplasty. It can enlarge the open area of facial recess and remove the lesion completely without increasing the chance of facial nerve injury.
【作者单位】：佛山市中医院耳鼻喉科;中山大学孙逸仙纪念医院耳鼻喉科;
【基金】：佛山市科技局医学类科技攻关项目(编号:201208051)
【分类号】：R764.92
【正文快照】： 完壁式鼓室成形术是经乳突及后鼓室切开、清除中耳及乳突腔病变组织,保留外耳道的完整性,并同期行鼓室成形的手术方法,与开放式手术相比,完壁式有利于保留中耳正常解剖结构与生理功能,避免开放术腔带来的不便,但同时也具有易残留病灶、术后复发及损伤面神经的缺点。随着面神经

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