不同方式半规管阻塞术治疗顽固性梅尼埃病疗效分析  

Various approaches in semicircular canal plugging for treatment of intractable Meniere's disease

作　　者：张道宫[1] 樊兆民[1] 韩月臣[1] 吕亚峰[1] 李亚伟[1] 王海波[1] Zhang Daogong;Fan zhaomin;Han Yuechen;Lv Yafeng;Li Yawei;Wang Haibo(Department of Otorhinolaryngology Head and Neck Surgery;Shandong Provincial Hospital affiliated with Shandong University;Shandong Provincial Key Laboratory of Hearing reconstruction, Jinan 250021,China)

机构地区：[1]山东大学附属省立医院耳鼻咽喉头颈外科,山东省立医院集团眼耳鼻喉医院耳鼻咽喉头颈外科,山东省听力重建重点实验室

出　　处：《中华耳科学杂志》2016年第4期446-450,共5页Chinese Journal of Otology

基　　金：国家自然科学基金(81200744);山东省科技发展计划项目(2011GGH21839)~~

摘　　要：目的通过不同方式半规管阻塞术治疗顽固性梅尼埃病的临床观察及疗效分析,对比分析不同阻塞方法对眩晕的控制及听力保留率,为梅尼埃病的个体化最佳治疗方案的选择提供依据。方法回顾性分析2010年12月至2016年1月我院328例行半规管阻塞术的梅尼埃病患者的临床资料。参照梅尼埃病的诊断依据和疗效评估(2006年,贵阳)标准,所有患者均临床诊断为单侧梅尼埃病,行规范化药物保守治疗至少1年以上,但眩晕仍反复发作。其中三个半规管阻塞术302例,两个半规管阻塞术21例,包括水平半规管联合后半规管阻塞15例,水平半规管联合上半规管阻塞6例;一个半规管阻塞术5例,均为水平半规管阻塞。采用纯音测听、前庭双温试验和颈源性前庭诱发肌源性电位(cervical vestibular evokedmyogenic potential,c VEMP)进行听力学和前庭功能评估,通过内耳MRI膜迷路水成像观察阻塞术后膜迷路的形态学改变。结果三个半规管阻塞术对眩晕控制的总有效率为98.0%(296/302),A级81.8%(247/302),B级16.2%(49/302),听力保留率70.2%(212/302);两个半规管阻塞术对眩晕控制的总有效率为85.7%(18/21),A级61.9%(13/21),B级23.8%(5/21),听力保留率76.2%(16/21);一个半规管阻塞对眩晕控制的总有效率为60.0%(3/5),A级40.0%(2/5),B级20.0%(1/5),听力保留率80.0%(4/5)。三个半规管阻塞术眩晕控制有效率高于两个半规管阻塞或一个半规管阻塞术(P<0.05)。听力保留率三组之间无明显差异(P>0.05)。结论半规管阻塞术是治疗顽固性梅尼埃病的有效方法。三个半规管阻塞术眩晕控制有效率最高。Objective To report vertigo and hearing outcomes following various approaches in semicircular canal pluggingin treating intractable Meniere’s disease. Methods Data from 328 patients with Meniere’s disease treated by authorsfrom December 2010 to January 2016 were reviewed. Unilateral Meniere’s disease was diagnosed in all patients accordingto the Standards of Diagnosis and Outcomes Assessment (Guiyang, 2006). All patients had received regular conservativetreatment for at least one year, with continuing recurrent vertigo attacks. Plugging was performed in 3 semicircular canals in302 cases, in 2 canals in 21 cases (horizontal-posterior canal plugging, n = 15; horizontal-superior canal plugging, n = 6)and in 1 canal in 5 cases (all horizontal canals). Pure tone audiometry, caloric tests and cervical vestibular evoked myogenicpotential (VEMP) were used for hearing and vestibular assessment. MRI membranous labyrinth imaging was used to observemembranous labyrinth morphology changes following plugging treatment. Results Total rate of vertigo control was 98.0% (296/302) for three canal plugging [class A 81.8% (247/302), class B 16.2% (49/302)] with hearing preservation in70.2% (212/302) of patients; 85.7% (18/21) for double canal plugging [class A 61.9% (13/21), class B 23.8% (5/21)] withhearing preservation in 76.2% (16/21) of patients; and 60.0% (3/5) in single canal plugging [class A 40.0% (2/5), class B20.0% (1/5) with hearing preservation in 80.0% (4/5) of patients. While vertigo control was the best among the three groups(P<0.05), there was no difference in hearing preservation (P>0.05). Conclusion Semicircular canal plugging is an effectivetreatment for intractable Meniere’s disease, with three canal plugging being the best in vertigo control.

关 键 词：梅尼埃病 半规管阻塞 治疗结果 

分 类 号：R764.33[医药卫生—耳鼻咽喉科]