超声吸引刀的磨骨功能在听神经瘤显微手术内听道处理中的应用  

3 Application of the grinding bone function of cut-ultrasound aspiration in internal auditory canal treatment of acoustic neuroma microsurgery

作　　者：孙守家[1] 高攀[1] 张晓静[1] 刘星[1] 游学峰 郭超[1] 孙强[1] 蒋伟[1] 舒凯[1] 雷霆[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《中华神经外科杂志》2016年第8期836-839,共4页Chinese Journal of Neurosurgery

基　　金：国家临床重点专科项目（2012303）

摘　　要：目的 探讨应用超声吸引刀（CUSA）的磨骨功能进行听神经瘤显微手术内听道处理的安全性及可靠性.方法 回顾性分析2014年1月至2015年6月华中科技大学同济医学院附属同济医院神经外科经枕下乙状窦后入路手术切除肿瘤的33例听神经瘤患者的临床资料.术中应用CUSA磨除内听道后上壁21例（CUSA处理组）,同时选择2012年5月至2013年10月术中使用磨钻处理内听道后上壁的19例患者作为对照组（磨钻处理组）.术中均行脑神经及脑干诱发电位等神经电生理监测.所有患者术前及术后1周内均采用House-Brackmann面神经功能分级系统进行面神经功能评估.结果 CUSA处理组肿瘤全切除20例（95％）.面神经解剖保留21例（100％）,实用听力保存5例（24％）.术后7 d House-Brackmann面神经功能分级Ⅰ级5例,Ⅱ级8例,Ⅲ～Ⅴ级8例,面神经功能良好的保留率为62％（13/21）.磨钻处理组肿瘤全切除17例（90％）.面神经解剖保留18例（95％）,House-Brackmann面神经功能分级Ⅰ级3例,Ⅱ级6例,Ⅲ～Ⅴ级10例,面神经功能良好的保留率为47％（9/19）.两组面神经功能良好的保留率差异有统计学意义（P＜0.05）.结论 应用CUSA在听神经瘤手术中处理内听道安全、有效,有利于肿瘤的全切除和面听神经的保护.Objective To investigate the safety and reliability of using the grinding bone function of cut-ultrasound aspiration （CUSA） to conduct internal auditory canal treatment during acoustic neuroma microsurgery. Methods From January 2014 to June 2015, the clinical data of 33 patients with acoustic neuroma resected via suboccipital retrosigmoid approach at the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were analyzed retrospectively. The posterior superior walls of the internal auditory canals in 21 patients （ CUSA group ） were ground by using CUSA during the operation, 19 patients treated with the posterior superior walls of internal auditory canal using the grinding drill from May 2012 to October 2013 were selected as a control group （ grinding drill group） in the operation at the same time. Electrophysiological monitoring, such as cranial nerve and brainstem auditory evoked potential were performed during the operation. House-Brackmann facial nerve function grading system was used to assess the facial nerve function for all patients within 1 week before and after procedure. Results The tumors of 20 cases （95%） in the CUSA group were totally removed. The facial nerves were preserved anatomically in 21 cases （ 100% ）, and the practical hearing was preserved in 5 cases （24%）. House-Brackmann facial nerve function grade at day 7 after procedure： grade I in 5 cases, grade Ⅱ in 8 cases, and grade m- v in 8 cases. The good reservation rate of facial nerve function was 62% （13/21）. In the grinding drill group, the tumors of 17 cases were totally removed （90%）, the rate of anatomical preservation of facial nerve was 95% （18/19）. House-Brackmann facial nerve function grade： grade I in 3 cases, grade I in 6 cases, and grade Ⅲ-V in 10 in cases, and the good reservation rate of facial nerve function was 47% （9/19）. There was significant difference in the good reservation rate of facialnerve function between the

关 键 词：神经瘤 听 显微外科手术 超声吸引刀 内听道 

分 类 号：R739.4[医药卫生—肿瘤]