内淋巴囊乳突引流术治疗梅尼埃病的远期疗效分析  

Long-term results of endolymphatic sac mastoid drainage for Ménière disease

作　　者：陈彪[1] 石颖[1] 拱月 陈婧媛[1] 崔丹默[1] 刘婷[1] 王杰[1] 郝欣平[1] 李永新[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉科耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第2期138-142,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金(No:81371088;No:81670923)

摘　　要：目的:评价内淋巴囊乳突引流术治疗梅尼埃病的远期疗效。方法:回顾性分析2006-2015年于首都医科大学附属北京同仁医院耳鼻咽喉头颈外科采用内淋巴囊乳突引流术治疗的26例梅尼埃病患者。参照《梅尼埃病诊断和治疗指南(2017)》,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,但眩晕仍然反复发作。所有患者随访至少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方面。结果:26例患者中男16例、女10例,年龄24~71岁,平均52.04岁;病程1~32年,其中单侧患病22例,双侧患病4例,患耳共30侧。30侧患耳中感音神经性聋19侧,混合性聋10侧。按术前听力进行临床分期后,一至四期患侧的例数分别为0,5,16,9。26例行内淋巴囊引流术的患者中术后眩晕A级(眩晕完全控制)15例(57.7%),眩晕B级(眩晕基本控制)9例(34.6%),眩晕D级(眩晕未控制)2例(7.7%),未出现眩晕加重者。评估眩晕发作的严重程度及对日常生活的影响,24例(92.3%)得到改善,得分均为0分,其余2例(7.7%)得分为2分。术后听力下降者(D级)7例(26.9%),听力无明显变化者(C级)16例(61.6%),听力明显提高者(A+B级)3例(11.5%)。所有患者术前耳鸣均达到2级及以上(2级4例,3级14例,4级8例),术后耳鸣消失(0级)5例(19.2%),耳鸣减轻且不影响睡眠及工作(1级+2级)13例(50%),耳鸣无明显改善(3级+4级)8例(30.8%)。术后耳闷胀感消失8例(30.8%),耳闷胀感减轻11例(42.3%),耳闷胀感无效7例(26.9%)。手术后均未出现面神经麻痹、脑脊液耳漏、出血、切口感染等并发症。结论:内淋巴囊乳突引流手术是治疗梅尼埃病安全有效的方法,对眩晕症状的控制效果满意,听力保存率较高。对于临床四期MD患者仍然可以从内淋巴囊乳突引流术中获益良多。Objective：To investigate the long-term efficacy of endolymphatic sac mastoid drainage for Ménière disease.Method：Data from 26 patients diagnosed with MD strictly meeting the criteria issued by ＂ Guideline of diagnosis and treatment of Meniere disease（2017）＂ from 2006 to 2015 were analyzed in this study.Endolymphatic sac mastoid shunt surgery was performed for each patient.The therapeutic effect was evaluated against the ＂ Guideline of diagnosis and treatment of Meniere disease（2017）＂.Vertigo control and auditory function were measured after at least two years follow up.Result：In 26 cases,16 cases were male and 10 cases were femaleThe age ranged from 24 to 71 years old,with an average of 52.04 years.The disease duration ranged from 1 to 32 years.22 cases were diagnosed as unilateral Ménière disease,and bilateral involvement was identified in 4 cases,thus a total of 30 ears were included.According to the preoperative staging of hearing,there were 0 cases in stage one,5 cases in stage two,16 in stage three and 9 cases in stage four.15 cases（57.7%）achieved class A vertigo conrol（complete control）,9 cases（34.6%）class B（substantial control）and 2 cases（7.7%）class D（no control）.The severity of vertigo and its impact on daily life were improved in 24 cases（92.3%）with a score of 0 point,and 2 cases（7.7%）scored 2 points.Post-operative hearing was improved in 3 cases（11.5%）,unchanged in 16 cases（61.6%）and worsened in 7 cases（26.9%）.After operation,tinnitus disappeared in 5 cases（19.2%）,reduced in 13 case（50%）and unchanged in 8 cases（30.8%）.Conclusion：Endolymphatic sac mastoid drainage was an effective and safe management for intractable Ménière disease patients with pre-operative residual hearing.The occurrence of complication was unsual.The patients who are in stage four could gain benifits from the surgery.with residual hearing before operation.The patients who are in stage four could get benifits from the surgery.

关 键 词：梅尼埃病 内淋巴囊 内淋巴囊乳突引流术 治疗效果 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]