中耳胆脂瘤伴面神经受累临床特点分析

发布时间：2018-03-26 05:54

本文选题：中耳胆脂瘤　切入点：开放式乳突根治术　出处：《中华耳科学杂志》2014年03期

【摘要】：目的探讨中耳胆脂瘤伴面神经受累的临床特点和诊治措施。方法采用回顾性分析方法,对2004年1月至2013年12月由本文通讯作者主刀完成、随访时间大于6个月的因中耳胆脂瘤行开放式乳突根治手术患者的临床资料进行总结,并对术中发现的面神经受累情况进行分析。入选的90例(92耳,其中双侧2例)患者中,男性46例,女性44例;左侧44耳,右侧48耳;平均年龄38岁6个月±13年5个月,平均随访时间3年5个月±2年10个月。所有患者术前均行颞骨薄层CT(水平位+冠状位)检查,部分患者同时行面神经骨管重建。手术采用开放式乳突根治术式,术中探查并记录从膝状神经节至乳突垂直段下端面神经骨管完整性,同时对术前伴有面瘫的患者行面神经减压。术前术后均采用House-Brackmann(HB)评分系统对患者的面神经功能进行评价。结果 92耳病例中,27耳(29.3%)在术中探查时发现面神经骨管部分破坏或缺失,其中位于膝状神经节+水平段(G+H)2耳(7.4%),水平段(H)19耳(70.4%),水平段+垂直段(H+V)3耳(11.1%),垂直段(V)3耳(11.1%)。4例(4耳)术前伴发面瘫,行开放式乳突根治及面神经减压术后6个月内,面神经功能逐渐改善。术前面神经功能正常的86例(88耳)中,83例(85耳)术后面神经功能正常;3例(3耳)在术后4-7d出现逐渐加重的迟发性轻度面瘫,最严重时达2-3级,发现后立即取出松解术腔填塞的碘仿纱条、予口服激素及维生素B12等对症处理,3个月复查时面神经功能均完全恢复正常(HB 1级)。结论中耳胆脂瘤伴面神经受累以水平段面神经骨管最为常见,术前高分辨CT对于预判面神经骨管完整性具有一定的参考价值。术前伴发面瘫时应尽快手术并同时行面神经减压术,乳突根治术腔填塞不宜太紧以避免压迫裸露的面神经,术后如出现即发或迟发性面瘫应立即对症处理并根据病情发展决定是否行减压术。
[Abstract]:Objective to investigate the clinical features, diagnosis and treatment of middle ear cholesteatoma with facial nerve involvement. The clinical data of patients with middle ear cholesteatoma undergoing open mastoidectomy for more than 6 months were summarized, and the facial nerve involvement found during the operation was analyzed. There were 46 males, 44 females, 44 left ears and 48 right ears. The mean age was 38 years, 6 months, 13 years and 5 months, and the mean follow-up time was 3 years, 5 months, 2 years and 10 months. Some of the patients underwent facial nerve bone canal reconstruction at the same time. Open mastoidectomy was performed. The integrity of facial nerve bone canal from the geniculate ganglion to the vertical segment of the mastoid process was explored and recorded during the operation. At the same time, facial nerve decompression was performed in patients with facial palsy before and after operation. House-Brackman 's nerve scoring system was used to evaluate the facial nerve function before and after operation. Results in 92 cases, 27 ears were found to be partially damaged or missing during intraoperative exploration. Among them, 7. 4 ears were located in the horizontal segment of the geniculate ganglia, 70.4 ears were located in the horizontal segment, 3 ears were located in the vertical segment of the horizontal segment and 11. 1% in the vertical segment) and 4 cases had facial palsy before operation. The patients were treated with open mastoidectomy and decompression of the facial nerve within 6 months after operation. The facial nerve function was improved gradually. 83 cases (85 ears) with normal facial nerve function before operation (83 cases with 85 ears) and 3 cases with normal facial nerve function (3 ears) with progressive aggravation of delayed mild facial paralysis at 4 to 7 days after operation, which reached 2-3 grade at the most serious stage. Immediately after discovery, take out the iodoform gauze that is filled in the cavity of the loosening operation. Oral administration of hormone and vitamin B12 showed that the facial nerve function was completely restored to HB1 grade after 3 months reexamination. Conclusion Middle ear cholesteatoma with facial nerve involvement is the most common in horizontal facial nerve bone canal. Preoperative high resolution CT scan has certain reference value for predicting the integrity of bone canal of facial nerve. Surgery and decompression of facial nerve should be performed as soon as possible before operation and radical mastectomy should not be too tight to avoid the compression of the exposed facial nerve. Immediate or delayed facial palsy should be treated immediately and decompression should be performed according to the development of the disease.
【作者单位】：中国医学科学院北京协和医学院北京协和医院耳鼻喉头颈外科;中国医学科学院北京协和医学院北京协和医院放射科;
【基金】：十二五国家科技支撑计划资助项目课题(项目/课题编2012BAI12B00/2012BAI12B01)
【分类号】：R764.21;R745.12

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