手术治疗周围性面瘫40例疗效分析  被引量:4

Surgical treatment of peripheral facial paralysis:analysis of 40 cases

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作  者:王侠[1] 宋建京 于晓伟[1] 王学海[1] 韩丽[1] 王培成[1] 张宇[1] 

机构地区:[1]威海市立医院耳鼻咽喉头颈外科,264200

出  处:《中华损伤与修复杂志(电子版)》2010年第4期42-45,共4页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘  要:目的探讨周围性面瘫患者发病原因、发病机制、有效的治疗方法及预后分析。方法对颞骨骨折及贝尔面瘫患者采用面神经减压术;面神经离断伤患者采用面神经吻合术;不能行面神经吻合患者则采用面神经移植转接手术治疗;术后配合神经营养药物及针灸治疗。结果对40例患者进行随访,发病1个月内与1~3个月以内手术治疗患者面神经功能恢复的疗效差异无统计学意义(P>0.05),而两者与3个月以上患者的疗效差异则有统计学意义(P<0.05)。28例颞骨骨折和4例贝尔面瘫患者行面神经减压术,面神经功能恢复Ⅰ级21例,Ⅱ~Ⅲ级7例,Ⅳ~Ⅴ级4例;2例患者行面神经端-端吻合,面神经功能恢复Ⅲ级;另外4例是听神经瘤、面神经鞘瘤切除术后行面神经-副神经、舌下神经转接吻合,面神经功能Ⅲ~Ⅳ级;2例腮腺肿瘤切除术后采用耳大神经、腓肠神经进行移植吻合,面神经功能Ⅳ级。结论周围性面瘫患者3个月以内手术治疗较3个月以上者效果好;颞骨骨折导致周围性面瘫患者行面神经减压术效果最好,面神经移植转接术效果最差。对周围性面瘫患者适时进行手术治疗是有必要而且是安全有效的。Objective To investigate the pathogenicity, mechanisms, surgical approaches and clinical curative effect of peripheral facial nerve paralysis. Methods Facial nerve decompression was performed on patients with temporal bone fracture and Bell parlsy. Facial nerve anastomosis was performed on patients with facial nerve damage. The transplanted facial nerve connecting operation was performed on patients who can not receive dialyneury. Neurotrophic medicine and acupuncture treatment were also done. Results Surgical treatment effect showed no statistical significant differences between the patients who had been ill for a month and one to three months ( P 〉 0.05 ). Surgical treatment effect of patients between within three months to three months had statistical significant differences ( P 〈 0.05 ). Twenty-eight cases with temporal bone fracture and 4 cases with Bell parlsy were performed with facial nerve decompression. Two cases injured in extracranial segment were applied with facial nerve anastomosis. Four cases caused by surgical trauma with acoustic neuroma and facial nerve sheath tumors underwent facial-accessory nerve anastomosis and facial-hy- poglossal nerve anastomasis, and the other 2 cases caused by surgical injury with parotid tumors were applied with facial nerve grafting. The recovered functions of facial nerve were judged by House and Braekmann grading system. Twenty one cases reached the first degree according to House-Brackmann facial nerve function scores after facial nerve decompression. Seven cases reached the second to third degree and 4 cases reached the fourth to fifth degree. Fourth cases performed facial-accessory nerve anastomosis and facial-hypoglossal nerve anastomasis reached the third to fourth degree, and the 2 cases after parotidectomy reached the fourth degree. Conclusions Surgical therapy should be undertaken in 3 months in patients with facial nerve paralysis. Facial nerve decompression is safe and effective, especially in cases caused by temporal bone fracture. But cases

关 键 词:面神经麻痹 创伤和损伤 减压术 外科 神经移植 

分 类 号:R651.1[医药卫生—外科学]

 

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