80例听神经瘤患者的临床特点及治疗选择分析  

Clinical Features and Treatment Strategy of Vestibular Schwannoma

作　　者：顾红波[1] 张燕梅[1] 钟贞[1] 王军[1] 吴园丁[1] 陈丽[1] 刘玉和[1] GU Hongbo;ZHANG Yanmei;ZHONG Zhen;WANG Jun;WU YuanDing;CHEN Li;LIU Yuhe(Department of Otolaryngology,First Hospital of Peking University)

机构地区：[1]北京大学第一医院耳鼻咽喉头颈外科,北京100034

出　　处：《中华耳科学杂志》2018年第3期325-331,共7页Chinese Journal of Otology

基　　金：北京市科委首都临床特色应用研究专项课题(项目编号:Z151100004015137)~~

摘　　要：目的探讨听神经瘤患者的临床特点及治疗选择策略。方法回顾性分析2009年1月至2017年12月就诊于北京大学第一医院的听神经瘤患者临床资料,统计并分析其临床特点及治疗方式选择。结果 80例听神经瘤患者中,男性34例,女性46例;年龄在18~80岁,中位年龄52岁;左侧26例,右侧54例;肿瘤桥小脑角最大径在0~76mm,根据Koos分级1、2、3、4级肿瘤分别有31、18、11、20例。内听道、脑桥小脑角、交界区肿瘤各31、30、19例。最常见的首发症状为渐进性听力减退和耳鸣,分别占42.5%和23.75%;其他首发症状包括突发性听力减退、头晕、头痛、耳闷、眩晕、三叉神经痛、走路不稳及面部麻木感。患者临床症状的前两位同样是听力减退及耳鸣,分别有83.57%和70%,既无耳鸣又无听力减退者仅占7.5%。根据WHO听力损失分级,正常、轻度、中度、重度、极重度感音神经性聋分别有11、9、19、3、38例,PTA≤60dB HL及PTA>60dB HL两组在肿瘤大小(P<0.01)及肿瘤位置(P<0.001)差异有统计学意义。重度听力损失以下患者18例行言语测听检查,言语识别率在≥90%、≥70%<90%、≥50%<70%、<50%各5、1、5、7例,根据AAO-HNS听力分级,A、B、C、D级各6、4、1、7例。接受随访观察、伽马刀治疗、手术治疗各有28、5、47例患者,手术组与随访观察组肿瘤Koos分级(P<0.001),听力水平(P=0.018)差异有统计学意义,年龄(50±14 VS 53±12,P=0.279)差异无统计学意义。28例接受随访观察患者,平均随访时间25.24个月,肿瘤增大者8例,无明显变化者20例。结论绝大多数听神经瘤患者会伴有耳部症状(听力减退、耳鸣),早期诊断有赖于耳鼻喉科医生对伴有耳部症状患者的筛查,对于小的肿瘤(<1.5cm),随访观察也可以取得良好的效果。Objective To report clinical features in patients with vestibular schwannoma and discuss over treatment strategies. Methods Patients seen at the First Hospital of Peking University from January 2009 to December 2017 for vestibular schwannoma were included and their clinical features and treatments were reviewed. Results Eighty patients （34 males and 46 females, aging from 18 to 80 years, median=52 years） were included in the study. Lesion was on left side in 26 and on right side in 54 patients. The maximal tumor size in the cerebellopontine angle was 0 to 76 mm （mean=21.93 mm）. Koos grading was I in 31 patients, II in 18 patients, III in 11 patients and IV in 20 patients. The tumor in-volved the internal auditory canal in 31 patients, the cerebellopontine angle in 30 patients and both in 19 patients. The most common initial clinical symptoms were progressive hearing loss （42.5%, 34/80） and tinnitus （23.75%, 19/80）. Oth-er initial symptoms included sudden hearing loss, vertigo, headaches, nausea, dizziness, trigeminal neuralgia, gait insta-bility and facial numbness. The two leading clinical complaints were hearing loss （83.57%） and tinnitus （70%）, with on-ly 7.5%of patients showing neither hearing loss nor tinnitus. According to WHO criteria, hearing was graded as normal in 11 patients, mild loss in 9 patients, moderate loss in 19 patients, severe loss in 3 patients and profound loss in 38 pa- tients. Tumor size （P＜0.01）and location （P＜0.001）were significantly different between patients with PTA≤60 dB HL and those with PTA＞60 dB HL. Eighteen of the 47 patients with hearing better than severe loss underwent speech audi-ometry test, and the speech discrimination score was≥90%in 5 patients,≥70%＜90%in 1 patient,≥50%＜70%in 5 pa-tients and＜50%in 7 patients. According to the AAO-HNS hearing classification, hearing was at level A in 6 patients, level B in 4 patient, level C in 1 patients and level D in 7 patients. Twenty eight patients received careful observation, 5 re

关 键 词：听神经瘤 临床特点 治疗策略 随访观察 

分 类 号：R764[医药卫生—耳鼻咽喉科]