中耳手术医源性面瘫的处理  

Management of Iatrogenic Facial Paralysis in Middle Ear Surgery

作　　者：韩月臣[1,2,3] 徐磊[1,2,3] 陈东[1,2,3] 樊兆民[1,2,3] 王海波[1,2,3] 

机构地区：[1]山东大学附属山东省立医院耳鼻咽喉头颈外科,山东250021 [2]山东省立医院集团眼耳鼻喉医院耳外科,山东250022 [3]山东省耳科学重点实验室,山东250022

出　　处：《中华耳科学杂志》2014年第3期426-428,共3页Chinese Journal of Otology

基　　金：国家自然科学基金(81271071);山东省科技发展计划(2012G0021838)

摘　　要：目的报道中耳手术中医源性面瘫的处理经验,并探讨医源性面瘫的原因、临床特点、处理方式及预防措施。材料与方法回顾分析1995-2014年45例中耳手术中发生医源性面瘫患者的临床资料,45例患者均接受再次手术探查,分析术中探查发现、面神经损伤的部位,程度,治疗选择及预后情况。45例患者中41例来自外院转诊。结果45例医源性面瘫中,44例为术中或术后即刻发生。术中探查发现,18例面神经损伤位于面神经水平段后部,约占40%,最为常见。根据神经损伤程度,23例选择单纯面神经减压术,11例选择切除神经纤维瘤样组织,离断部分行端端吻合,其余11例行神经间位移植。44例患者术后随访超过1年,32例患者面神经功能恢复至HB分级Ⅲ级以内。结论医源性面瘫是中耳手术的严重并发症之一,多于术中或术后即刻发生,尽早手术探查,并予以正确处理,可以获得较好的面神经功能恢复。Objective To report authors’experiences with iatrogenic facial paralysis in middle ear surgery, and discus its causes, clinical characteristics, treatments and prevention. Methods From 1995 to 2014, 45 cases of iatrogenic facial pa-ralysis associated with middle ear surgery in our hospital were included in this retrospective study, of which 41 were referrals from other hospitals. All of these cases received revision surgery and the results of exploration were analyzed, including the po-sition, pathological injury degree, and outcomes of the facial nerve damage. Results Facial nerve paralysis were found during or immediately after surgery in 44 cases. The damages of the facial nerve located in the posterior portion of the tympanic seg-ment in 18 cases （40%）. Based on evaluation of damage degree, decompression was performed in 23 cases, partial facial nerve graft in 11 cases, and interposition facial nerve graft in 11 cases. Forty four cases were followed up for more than one year, and facial nerve function in 32 cases was better than HB-III one year after surgery. Conclusions Itrogenic facial paralysis is one of the serious complications of middle ear surgery, which is always identified during or immediately after surgery. The results of facial function were satisfactory if the facial nerve is explored and treated correctly at an time.

关 键 词：医源性面瘫 中耳手术 

分 类 号：R764.92[医药卫生—耳鼻咽喉科] R745.12[医药卫生—临床医学]