内淋巴囊乳突引流术治疗梅尼埃病疗效分析  

Efficacy of endolymphatic sac-mastoid shunt surgery for intractable Meniere＇s disease

作　　者：张道宫[1] 樊兆民[1] 史宏璐[2] 韩月臣[1] 吕亚峰[1] 李亚伟[1] 王光彬[2] 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 [2]山东大学医学院山东省医学影像学研究所

出　　处：《中华耳鼻咽喉头颈外科杂志》2015年第9期729-732,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：基金项目：国家自然科学基金（81200744）;山东省科技发展计划项目（2011GGH21839）

摘　　要：目的 探讨不同听力分期梅尼埃病患者内淋巴囊乳突引流术的远期疗效,评价其有效性和安全性以及手术时机的选择.方法 回顾性分析山东大学附属省立医院耳鼻咽喉头颈外科1983年1月至2012年1月共240例接受内淋巴囊乳突引流术治疗的梅尼埃病患者的临床资料.参照梅尼埃病的诊断依据和疗效评估（2006年,贵阳）标准,所有患者均临床诊断为梅尼埃病,行规范化药物保守治疗至少1年以上,但眩晕仍反复发作.所有患者随访时间均满2年,治疗效果的评价主要包括眩晕的控制情况、听力情况及工作生活能力等三个方面.结果 240例内淋巴囊手术患者,按术前听力进行分期,Ⅰ期12例,Ⅱ期130例,Ⅲ期85例,Ⅳ期13例.术后2年随访时,眩晕A级（完全控制）118例（49.2％）,B级（基本控制）69例（28.7％）,总的眩晕控制率为77.9％ （187/240）.术后听力提高60例（25.0％）,无明显变化142例（59.2％）,听力下降38例（15.8％）.手术后均无面神经麻痹、脑脊液漏、出血、切口感染等并发症.Ⅰ期患者眩晕控制率为83.3％ （10/12）,Ⅱ期患者为82.3％（107/130）,Ⅲ期患者为75.3％（64/85）,Ⅳ期为46.2％ （6/13）.经统计学分析（x^2检验）,Ⅳ期患者眩晕控制率明显低于Ⅱ、Ⅲ期患者（x^2=9.318、4.692,P值均＜0.05）,而Ⅰ、Ⅱ、Ⅲ期患者之间眩晕控制率差异无统计学意义（P值均＞0.05）.结论 内淋巴囊乳突引流手术治疗顽固性梅尼埃病安全、有效,对眩晕症状的控制效果满意,听力保存率较高,但对于Ⅳ期梅尼埃病患者疗效较差.Objective To investigate the effect and mechanism of endolymphatic sac-mastoid shunt surgery for intractable Meniere＇s disease of different stages according to hearing level.Methods Data from 240 patients diagnosed with unilateral MD strictly meeting the criteria issued by Chinese Academy of Otolaryngology-Head and Neck Surgery Committee （2006） from January 1983 to January 2012 were analyzed in this study.Endolymphatic sac-mastoid shunt surgery was performed in affected ear for each patient.The evaluation of therapy followed the guidelines issued by Chinese Academy of Otolaryngology Head and Neck Surgery Committee.Vertigo control and auditory function were measured in two-year＇s follow-up.Results According to the preoperative staging of hearing,among these 240 patients,there were 12 cases in stage Ⅰ （with an average hearing threshold 〈 25 dB）,130 cases in stage Ⅱ （with an average hearing threshold of 25-40 dB）,85 in stage Ⅲ （41-70 dB） and 13 cases in stage Ⅳ（with an average hearing threshold 〉 70 dB）.Overall control rate of vertigo was 77.9% （187/240） in two-year＇s follow-up,with total control 49.2% （118/240） and substantial control 28.7% （69/240）.The hearing was improved in 25.0% （60/240） of cases,no change in 59.2% （142/240） of cases,and worse in 15.8% （38/240） of cases.According to different stages,vertigo control rate was 83.3% （10/12） in stage Ⅰ,82.3% （107/130）in stage Ⅱ,75.3% （64/85） in stage Ⅲ and 46.2% （6/13） in stage Ⅳ.Vertigo control rate of stage Ⅳ patients was significantly lower than that of stage Ⅱ and Ⅲ patients （x^2 =9.318 and 4.692,P 〈 0.05）,while vertigo control rate of stage Ⅰ,Ⅱ,Ⅲ patients had no significant difference with each other （P 〉 0.05）.Conclusion Endolymphatic sac-mastoid shunt operation is an effective method in the treatment of intractable Meniere＇s disease,but the effect was poor in stage Ⅳ patients.

关 键 词：梅尼埃病 内淋巴囊 内淋巴分流术 治疗结果 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]