乳突根治术中面神经裸露情况分析  

Incidence of facial nerve dehiscence in mastoidectomy

作　　者：叶放蕾[1] 朱晓丹[1] 陈蓓[1] 郝少娟[1] 

机构地区：[1]郑州大学第一附属医院耳鼻咽喉头颈外科,450052

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第7期597-601,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 总结中耳胆脂瘤及慢性化脓性中耳炎乳突根治术中面神经情况,为临床医师提供手术参考.方法 回顾性分析360例（370耳）行乳突根治术的慢性化脓性中耳炎（145耳）及中耳胆脂瘤（225耳）患者的临床资料,记录术中面神经裸露情况及其发生部位,应用SPSS 17.0软件单因素分析年龄、病程、病理类型、面神经低位、术前面神经麻痹以及并发迷路瘘等因素与面神经裸露的关系.结果 370耳中面神经裸露117耳,总裸露率为31.6％,最常见的发生部位是鼓室段（106耳,占90.6％）.未成年患者的面神经裸露率为61.1％ （22/36）,成年患者为28.4％ （94/334）,差异具有统计学意义（P＜0.05）;病程5年以上患者的面神经裸露率为37.1％ （104/280）,病程5年以下患者的面神经裸露率为14.4％（13/90）,差异具有统计学意义（P＜0.05）;中耳胆脂瘤患者的面神经裸露率为39.1％（88/225）,慢性化脓性中耳炎患者的面神经裸露率为20.0％（29/145）,差异具有统计学意义（P＜0.05）.面神经低位的发生率为11.4％（42/370）,面神经低位时发生裸露的比例为83.3％（35/42）,明显高于面神经走形正常者,差异具有统计学意义（P＜0.05）;迷路瘘的发生率为7.8％（29/370）,有迷路瘘者面神经裸露发生率为65.5％（19/29）,高于无迷路瘘患者的28.7％（98/341）,差异具有统计学意义（P＜0.05）;术前面神经麻痹患者面神经裸露率为75.0％ （18/24）,高于术前无面神经麻痹患者的28.6％（99/346）,差异具有统计学意义（P＜0.05）.结论 慢性化脓性中耳炎及中耳胆脂瘤患者面神经裸露发生率31.6％,好发于鼓室段.病程长、合并迷路瘘管、中耳胆脂瘤、术前面神经麻痹等因素提示面神经裸露的风险较大.Objective To describe the incidence and location of the facial nerve dehiscence（FND） in chronic suppurative otitis media patients with and without cholesteatoma. Methods 360 patients （370 ears） who received canal wall down tympanomastoidectomy due to otitis media （145 ears without cholesteatoma and 225 ears with cholesteatoma） were analyzed retrospectively, in which the incidence and locations of FND was studied, and the relevance for FND, clinical features （age, disease duration, preoperative facial paralysis ） and intraoperative findings （state of FND and lateral semicircular canal fistula）, were analyzed. Results The presence of FND was 31.6% of total surgical procedures and the locations of FND were the tympanic segment. The dehiscence was detected 28.4% （94/334）in adults, but 61.1% （22/36） in the patients 18 years and younger, the differences were statistical significance （P 〈 0. 05）. The dehiscence rate was 37. 1% （104/280）and 14.4% （13/90） respectively, in the cases of disease duration more than and less than 5 years, with significant difference （P 〈 0. 05 ）. Facial nerve dehiscence was detected in 29 patients（20. 0% ） and 89 （39. 1% ） in cases without and with cholesteatoma respectively（P 〈 0.05 ）. Facial nerve prolapse over the oval window was 11.4% （42/370）, with FND of 83.3% （ 35/42 ）. The incidence of lateral semicircular canal fistula was 7.8% （ 29/370 ）, with FND of 65.5% （ 19/29 ）. The presence of preoperative facial paralysis with FND was 75.0% （ 18/24 ）, and that without FND was 28. 6% （ 99/346 ）, the differences were statistical significance （ P 〈 0. 05 ）. Conclusions The incidence of FND most commonly located at the tympanic segment. The facial nerves should be taken much care in mastoidectomy for patients with cholesteatoma, preoperative facial paralysis and lateral semicircular canal fistula, as well as long disease duration.

关 键 词：胆脂瘤 中耳 中耳炎 化脓性 耳外科手术 面神经 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]