中耳手术中鼓索神经的保护与效果分析  

The Protecting Effects of the Technique on the Chorda Tympanic Nerve in Middle Ear Surgery

作　　者：张宏征[1] 蔡洁青 许木清 赖小思 舒繁[1] 邹团明[2] 

机构地区：[1]南方医科大学珠江医院耳鼻咽喉科,广州510282 [2]佛山市第一人民医院耳科

出　　处：《听力学及言语疾病杂志》2017年第4期382-384,共3页Journal of Audiology and Speech Pathology

摘　　要：目的探讨中耳手术中鼓索神经的处理方法及保护鼓索神经的可行性和必要性。方法以2013年9月~2016年3月行中耳手术的155例(155耳)患者为研究对象,男86例,女69例,年龄19~65岁,平均38.23±5.7岁;其中,鼓室成形术I型24例,上鼓室切开+鼓室成形术I型6例,上鼓室切开+鼓室成形术II型22例,完壁式乳突切开+鼓室成形术23例,开放式乳突切开+鼓室成形术74例,镫骨底板钻孔+活塞人工镫骨植入术6例,均记录手术中鼓索神经显露和保护的方法,并观察患者术后3天和术后1月时同侧舌的味觉。结果 155例中,12例术中未暴露鼓索神经,126例术中完整保留之,故鼓索神经保存率为89.03%(138/155),鼓索损伤的17例中15例(88.2%,15/17)术后3天和术后1月时舌味觉减退;鼓索神经保护完整的126例中13例(10.3%,13/126)术后3天味觉减退,均于术后1个月内自行恢复;1例在术后16天发生迟发性面瘫,经糖皮质激素治疗2周后完全恢复。在鼓索神经保护完整与术中鼓索神经断裂这两部分病例间术后3天和术后1个月时味觉异常发生率差异均有统计学意义(χ~2=57.753,P=0.000;χ~2=124.2,P=0.000)。结论根据鼓索神经的走行位置和显露方式不同,在中耳手术中采取个体化的措施保护鼓索神经是可行的,可使患者术后味觉功能保持良好。Objective To investigate the different exposure and treatment methods for the chorda tympanic nerve in middle ear surgery,and discuss the surgery techniques and the feasibility of the chorda tympanic nerve protection.Methods From September 2013 to March 2016,155 cases of middle ear surgeries at Zhujiang hospital were included in this study,including 24 cases of type I tympanoplasty,6 cases of atticotomy and type I tympanoplasty,22 cases of atticotomy and type II tympanoplasty,23 cases of canal-wall-up mastoidectomy and tympanoplasty,74 cases of canal-wall-down mastoidectomy and tympanoplasty,6 cases of stapedotomy.The conditions of exposure and protection of the chorda tympanic nerve in the operation were compared,and their taste function at 3 days to 1 months postoperatively through questionnaires were evaluated.Results The preservation rate of the chorda tympanic nerve was up to 89.03%（138/155）.There were 17 cases of chorda tympanic nerve injuries,of which 15 cases suffered hypogeusia with the rate being 88.2%（15/17）.In 126 cases of the complete protection of the chorda tympanic nerve,13 of them appeared hypogeusia at 10.3%（13/126）,but they recovered within 1 months postoperatively.One case of delayed facial paralysis occurred in 16 days postoperatively,and recovered completely after 2 weeks of treatment with glucocorticoids.There was a significant difference in the incidence of postoperative abnormal taste between the complete protection of the chorda tympanic nerve and fracture during operation.Conclusion According to the different position and exposure of chorda tympanic nerve,the individual measures should be taken in middle ear surgery to protect the chorda tympanic nerve.

关 键 词：中耳手术 鼓索神经 手术技巧 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]