半规管阻塞术治疗顽固性梅尼埃病的短期疗效分析  

Short-term efficacy of semicircular canal occlusion in the treatment of intractable Meniere＇s disease

作　　者：樊兆民[1] 张道宫[1] 韩月臣[1] 王海波[1] 

机构地区：[1]山东大学附属省立医院耳鼻咽喉头颈外科山东省耳科学重点实验室,济南250021

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第8期677-679,共3页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：山东省科技发展计划项目（2007GG20002041,2011GGH21839）

摘　　要：目的观察半规管阻塞术治疗顽固性梅尼埃病的短期疗效，评价其有效性和安全性。方法回顾性分析17例行半规管阻塞手术的梅尼埃病患者资料，均为确诊单侧梅尼埃病，行规范化药物保守治疗至少1年以上，眩晕仍反复发作者。全麻下经乳突进路行三个半规管阻塞术，术后随访6～13个月，平均10个月。术前及术后3个月采用纯音测听、冷热试验和前庭诱发的肌源性电位检查（vestibular evoked myogenic potential，VEMP）进行听力学和前庭功能评价。结果17例梅尼埃病患者，术前按听力进行分期，Ⅱ期（平均听阈25-40dBHL）2例，Ⅲ期（41～70dBHL）15例。术后随访期内均无眩晕发作，眩晕控制率为100％（17／17）。同期行内淋巴囊减压术的25例梅尼埃病患者，眩晕控制率为72．O％（18／25），半规管阻塞术的眩晕控制率高于内淋巴囊减压术（X2=3．87，P〈0．05）。术后3个月12例患者纯音平均听阈与术前相比无明显变化，5例听阈提高，但均小于20dBHL，听力下降率29．4％（5／17）。术后所有患者均出现短时间眩晕及平衡障碍，眩晕均在术后3d内消失，10例患者术后1～2周内恢复平衡功能，7例患者术后2个月内平衡障碍完全消失，平衡恢复时间平均12．6d。术后3个月复查，全部病例冷热试验均提示半规管功能丧失，VEMP检查示球囊功能无变化。所有患者均无面神经麻痹、脑脊液漏等并发症发生。结论半规管阻塞术治疗顽固性梅尼埃病短期疗效确切，听力保留率高，不影响耳石器功能，无严重并发症，有望成为治疗存在中度以上听力损失的顽固性梅尼埃病患者安全有效的手术方法。Objective To investigate the short-term efficacy and safety of triple semicircular canal occlusion （TSCO） in the treatment of intractable Meniere^s disease （MD） , so as to provide an alternative surgical procedure for treating MD. Methods Seventeen patients, who had received standardized conservative treatment for at least one year with poor effect, underwent TSCO were retrospectively analyzed. Vertigo control and auditory function were evaluated. Pure tone audiometry, caloric test, and vestibular evoked myogenic potential （VEMP） were performed for evaluation of audiological and vestibular function. Postoperative follow-up period was 6-13 months, with an average of ten months. Results According to the preoperative staging of hearing, among the 17 patients, there were 2 cases in stage Ⅱ （with an average hearing threshold of 25-40 dBHL） and 15 in stage Ⅲ （41-70 dBHL）. No vertigo was found during the follow-up period, with 100% control rate of vertigo. During the same period, we had performed endolymphatic sac decompression operation in 25 MD patients. The control rate of vertigo was 72.0%. The vertigo control rate of TSCO was significantly higher than that of endolymphatic sac decompression operation （ X2 = 3.87, P 〈 0.05）. Three months after surgery, 12 patients showed no significant change in comparison to primary status, 5 patients presented with an mild increase in the average hearing threshold of less than 20 dBHL, with 29.4% of hearing loss rate. Post-operatively, all patients suffered from temporary vertigo and balance disorders. Vertigo was disappeared in all patients within 3 days, while, balance disorders were disappeared in 10 patients within 1-2 weeks after surgery, and in another 7 patients within 2 months, with an average recovery time of 12.6 days. Three months after treatment, loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in VEMP test was noted. All patients had no facial paralysis, cerebrospinal fluid

关 键 词：梅尼埃病 半规管 耳外科手术 治疗结果 

分 类 号：R764[医药卫生—耳鼻咽喉科]