大型听神经瘤术后面神经功能的影响因素  

Factors affecting facial nerve function after surgery of large acoustic neuroma

作　　者：王菁菁 张博雅 胡怡冰 范历强 于栋祯[1] 陈正侬[1] 殷善开[1] Wang Jingjing;Zhang Boya;Hu Yibing;Fan Liqiang;Yu Dongzhen;Chen Zhengnong;Yin Shankai(Department of Otolaryngology-Head and Neck Surgery,Shanghai Jiao Tong University School of Medicine Affiliated Sixth People′s Hospital,Shanghai Hearing Test Center,Otolaryngology Institute of Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院耳鼻咽喉头颈外科,上海市听力测试中心,上海交通大学耳鼻咽喉科研究所,上海200233

出　　处：《中华医学杂志》2023年第44期3535-3540,共6页National Medical Journal of China

基　　金：国家自然科学基金(82071040);上海市2022年度“科技创新行动计划”启明星项目-启明星培育(扬帆专项)(22YF1432700)

摘　　要：目的探讨大型听神经瘤术后面神经功能的影响因素。方法回顾性分析2015年4月至2022年4月于上海交通大学医学院附属第六人民医院耳鼻咽喉头颈外科接受扩大迷路径路手术治疗的大型听神经瘤患者的临床资料。以House-Brackmann(HB)面神经功能分级作为面神经功能评价指标对所有患者术前、术后2周及术后1年的面神经功能进行评估分级。采用多因素logistic回归分析影响大型听神经瘤患者术后面神经功能的相关因素。结果共纳入102例大型听神经瘤患者,男44例(43.1%),女58例(56.9%),年龄(49.9±11.4)岁。肿瘤全切除率为90.2%(92/102),无围手术期死亡病例。随访时间2(1,5)年。术后早期(术后2周出院时)及远期(随访时间满1年)面神经功能良好率(HBⅠ~Ⅲ级)分别为73.5%(75/102)和87.3%(89/102)。多因素logistic回归分析结果显示,手术结束时面神经探测阈值>0.05 mA为大型听神经瘤术后近期(OR=6.782,95%CI:1.520~30.272,P=0.012)及远期(OR=11.455,95%CI:2.182~60.146,P=0.004)面神经功能恢复不良的影响因素。结论术后近期及远期面神经功能与手术结束时面神经探测阈值相关,阈值≤0.05 mA提示术后面神经功能可能恢复良好。Objective To explore factors affecting facial nerve function after surgery of large acoustic neuroma.Methods The data of patients with large acoustic neuroma who underwent microsurgery by the enlarged translabyrinthine approach in the Department of Otolaryngology-Head and Neck Surgery of Shanghai Jiao Tong University School of Medicine Affiliated Sixth People′s Hospital between April 2015 and April 2022 were retrospectively analyzed.According to the House-Brackmann(HB)grading system,facial nerve function of all patients before surgery,within 2 weeks and 1 year after surgery was evaluated.Multivariate logistic analyses were used to assess the related factors affecting facial nerve function in patients with large acoustic neuroma.Results A total of 102 patients were collected,including 44 males(43.1%)and 58 females(56.9%),with a mean age of(49.9±11.4)years.The gross total resection rate was 90.2%(92/102)and there were no perioperative deaths.The follow-up time was 2(1,5)years.The good(HBⅠ-Ⅲ)rate of early postoperative(2 weeks after surgery)and long-term(1-year follow-up)facial nerve function was 73.5%(75/102)and 87.3%(89/102),respectively.Multivariate logistic regression analysis showed that facial nerve detection threshold>0.05 mA at the end of surgery(OR=6.782,95%CI:1.520-30.272,P=0.012 and OR=11.455,95%CI:2.182-60.146,P=0.004)was associated with poor functional recovery of facial nerve after surgery for large acoustic neuromas.Conclusions The short-term and long-term facial nerve function after surgery correlates with threshold value of facial nerve detection at the end of surgery.The threshold≤0.05 mA indicates that the facial nerve function may recover well after the surgery.

关 键 词：听神经瘤 手术 面神经功能 扩大迷路径路 

分 类 号：R739.43[医药卫生—肿瘤]