内镜在迷路后进路手术中的应用  

The Use of Endoscope in Retrolabyrinthine Approach for Cerebellopontine Angle Region Surgeries

作　　者：李晓华[1] 杨洁 朱伟栋[2,3,4] 柴永川 贾欢[2,3,4] 汪照炎 吴皓[2,3,4] 

机构地区：[1]郑州大学第一附属医院耳科,郑州450052 [2]上海交通医学院附属第九人民医院耳鼻咽喉头颈外科,上海200011 [3]上海交通大学医学院耳科研究所,上海200092 [4]上海耳鼻疾病转化医学重点实验室,上海200092

出　　处：《中华耳科学杂志》2017年第4期398-402,共5页Chinese Journal of Otology

基　　金：国家自然科学基金面上项目(81470681;81570906;81670919;82371086)~~

摘　　要：目的探讨内镜在迷路后进路手术中的临床应用价值。方法回顾性分析2010年1月至2016年1月收治的32例侧颅底患者的临床病例资料,男19例,女13例,年龄35-69岁,其中颅神经疾病27例(梅尼埃病20例,面肌痉挛5例,三叉神经痛2例),桥小脑角胆脂瘤3例,听神经瘤2例。所有病例均采用内镜辅助下迷路后进路完成,术后均随访1~5年,对手术效果进行分析。结果 27例颅神经病变患者术后症状均消失,其中20例梅尼埃患者行前庭神经切断术,术后眩晕控制率100%;5例面肌痉挛患者行面神经微血管减压术,术后面部痉挛症状完全缓解;2例三叉神经痛患者行三叉神经微血管减压术,术后疼痛症状消失。以上27例颅神经病变患者的术后面神经功能良好,所有病例听力与术前相比均无明显下降,无并发症,随访1-5年,无复发。3例桥小脑角胆脂瘤患者,胆脂瘤均彻底切除,术后无一例出现面神经麻痹或其他颅脑并发症,术后1例患者出现听力丧失,2例保存实用听力,随访1-5年,胆脂瘤无复发。2例听神经瘤患者肿瘤均全切除,术后均保存实用听力,无一例出现面神经麻痹或其他颅脑并发症,随访1-5年,肿瘤无复发。结论内镜辅助的迷路后进路,在功能性颅神经手术中具有良好的应用价值,能够清晰显露责任血管和V^XI颅神经,手术效果好;在桥小脑角胆脂瘤及听神经瘤手术中,内镜可以多角度无死角地观察,并做到微创全切除病变。Objective To report application of endoscope in the retrolabyrinthine approach of cerebellopontine angle surgery.Methods A total of 32 patients undergone endoscopic surgeries for CPA lesions via retrolabytinthine approach from January 2010 to January 2016 were reviewed, including 19 males and 13 females with ages ranging from25-69 years. Surgery indications included cranial neuropathy（n=27, Meniere＇s disease n=20, hemifacial spasm n=5, trigeminal neuralgia n=2）, CPA cholesteatoma（n=3） and vestibular schwannnoma（n=2）. Patients were followed up for1-5 years. Results Symptoms in the 27 cases of cranial neuropathy resolved after surgery. Vestibular neurectomy was performed in the 20 cases of Meniere＇s disease and the rate of postoperative vertigo control was 100%. Microvascular decompression of the facial nerve was done in the 5 cases of hemifacial spasm with complete remission of facial spasm symptoms after surgery. Trigeminal nerve microvascular decompression in the 2 cases of trigeminal neuralgia also brought symptoms resolution after operation. There were no complications, nor clinical recurrence during the 1-5 years follow-up. Total lesion removal was achieved in all 3 patients with CPA cholesteatoma without facial palsy or other neurological deficits. Useful hearing was preserved in two patients, and no matrix recurrence was found during the 1-5years follow-up. Tumor removal was total without facial palsy or other neurological deficits in the 2 patients with vestibular schwannomas, with preservation of useful hearing and no tumor recurrence during the 1-5 years follow-up in both patients. Conclusions Endoscopic assisted retrolabyrinthine approach has good application value in functional cranial nerve surgeries. It provides excellent exposure of the responsible blood vessel and cranial nerves（CN） V-XI. In cerebellopontine angle cholesteatoma and acoustic neuroma surgeries, endoscopy can help achieve minimally invasive resection of lesions.

关 键 词：内镜 迷路后进路 桥小脑角区域疾病 

分 类 号：R764[医药卫生—耳鼻咽喉科]