完壁式鼓室成形术中面神经监测的临床应用  

Facial Nerve Monitoring during Canal Wall Up Mastoidectomy and Tympanoplasty

作　　者：纪树芳[1] 陈学华[1] 李卡凡[1] 蔡小剑[1] 许耀东[2] 

机构地区：[1]佛山市中医院耳鼻喉科,佛山528000 [2]中山大学孙逸仙纪念医院耳鼻喉科,广州510120

出　　处：《中华耳科学杂志》2014年第4期587-589,共3页Chinese Journal of Otology

基　　金：佛山市科技局医学类科技攻关项目(编号:201208051)

摘　　要：目的：探讨面神经监测仪在完壁式鼓室成形术中的应用价值。方法在面神经监测下完成完壁式鼓室成形术21例，术中在解剖定位的基础上用面神经监测仪确认面神经的走行，尤其经面隐窝进路开放后鼓室过程中实时监测预防损伤面神经，记录开放前后刺激阈值。结果术中发现面神经前移1例。完成完壁式手术的21例患者中，面隐窝进路开放后鼓室前面神经乳突段刺激阈值为0.38～0.90mA，平均（0.66±0.16）mA，开放后面神经乳突段刺激阈值为0.16～0.43mA,平均（0.32±0.09）mA。经配对t检验，差异有统计学意义（p＜0.05）。术中发现面神经骨管缺损4例。术后无一例患者出现即发性或迟发性面瘫。术后半年全部干耳。结论面神经监测仪能在完壁式鼓室成形术中有效识别面神经，有助于扩大面隐窝的开放范围、彻底清除病灶而不增加面神经损伤的机会。Objective To study the value of facial nerve monitoring during canal wall up mastoidectomy with tympano？plasty. Methods Canal wall up mastoidectomy was performed in 21 cases of chronic suppurative otitis media through facial re？cess approach with intraoperative facial nerve monitoring. Stimulus thresholds before and after opening the facial recess were recorded.Results Abnormally anterior course of facial canal was seen in 1 case. In the 21 cases in which canal wall up sur？gery was completed, the stimulus thresholds at the mastoid segment ranged from 0. 38~0. 90 mA（mean=0.66±0.16 mA）be？fore opening the facial recess and 0.16~0.43 mA（mean=0.32±0.09 mA）after facial recess was opened（p〈0.05）. Facial ca？nal defects were found in 4 cases under microscopes. There was no immediate or delayed facial paralysis after surgery. All patients obtained dry ear at six months follow up. Conclusion Intraoperative facial nerve monitoring can help surgeons identify and locate the facial nerve, facilitating broad facial recess access in canal wall up surgery while effectively protecting the facial nerve.

关 键 词：完壁式鼓室成形术 面神经监测 

分 类 号：R322.922[医药卫生—人体解剖和组织胚胎学] R322.921[医药卫生—基础医学]