面神经瘤5例临床分析  

Clinical Analysis of 5 Cases of Facial Nerve Tumors

作　　者：戴炳译 关兵[1] 于爱民[1] 曹武[3] 曹清[1] Dai Bingyi;Guan Bing;Yu Aimin;Cao Wu;Cao Qing(Northern People's Hospital of Jiangsu Province,Department of Otolaryngology-Head andNeck Surgery,Yangzhou University Medical School,Yangzhou,225001,China)

机构地区：[1]江苏省苏北人民医院耳鼻咽喉-头颈外科,扬州225001 [2]扬州大学医学院 [3]中南大学湘雅二医院耳鼻咽喉科

出　　处：《听力学及言语疾病杂志》2018年第4期396-399,共4页Journal of Audiology and Speech Pathology

摘　　要：目的探讨面神经瘤的临床特点,诊断和治疗方法。方法回顾性分析2005年2月~2016年6月江苏省苏北人民医院收治的5例面神经瘤患者的临床资料,分析其临床症状、体征特点,诊断要点及手术技巧。结果5例患者均表现为中、重度面瘫,按HB分级法,面神经功能Ⅲ级2例,Ⅳ级1例,Ⅵ级2例,其中面瘫病程1年以内3例,1年半1例,18年1例。5例均伴一定程度听力下降,1例感音神经性聋,言语频率纯音平均听阈60dB HL,1例传导性聋,言语频率纯音平均听阈65dB HL;3例混合性聋,言语频率纯音平均听阈分别为65、80、100dB HL。3例患者术前磁共振成像(MRI)示瘤体累及面神经水平段及垂直段,1例累及腮腺,近颈静脉孔区,1例接近桥小脑角及内听道段。所有患者均行手术治疗,其中3例经乳突径路、2例经颞下窝A型径路手术,切除肿瘤同时行Ⅰ期面神经重建3例,肿瘤与面神经同时切除2例;术后病理报告面神经鞘瘤4例,面神经纤维瘤1例。随访6个月~7年,均未复发。3例Ⅰ期面神经重建的患者中2例面神经功能Ⅳ级、1例Ⅴ级。结论面神经瘤术前需行高分辨率CT(HRCT)或MRI检查,为手术方式选择提供依据;目前治疗方法以手术为主,彻底切除肿瘤同时应尽可能保留面神经纤维或术中行面神经重建术。Objective To study the clinical manifestation,diagnosis and treatment of facial neuroma(FN).Methods A retrospective study was carried out to study 5 cases with facial nerve tumor treated in northern people’s hospital from February 2005 to June 2016 by reviewing their clinical manifestation,audiology examination,imaging and pathological diagnosis,and the surgical treatment experience.All the patients were treated with pure tone and enhanced CT and MRI examination after admission.Results All 5 patients had moderate and severe facial paralysis,including 3 cases of facial paralysis within 1 year,1 case within a year and a half,and 1 case within 18 years.They had a certain degree of hearing loss,and three cases of preoperative MR showed the tumor associated with the level of facial nerve and vertical segment;1 case involved the parotid gland and proximal jugular foramen region;1 case was close to the cerebellopontine angle and the internal auditory canal segment.The facial nerve functions were graded by HB facial nerve grading system,including 2 cases of gradeⅢ,1 case of grade IV and 2 cases of gradeⅥ.They were all treated by surgery,with 3 cases operated via mastoid process approach and 2 cases via infratemporal fossa approach.All 5 tumors were totally removed with 3 cases’facial paralysis who recovered at a certain degree and 2 cases'facial nerve function HB VI.In this group of cases,4 were diagnosed as neurilemmoma and 1 as neurofibroma of facial nerve post operation.Conclusion It is very important for facial nerve tumors to get a correct diagnosis at its early stage by HRCT or MRI.For patients with facial paralysis,the current treatment method is mainly surgery.When the tumor is removed completely,we should preserve facial nerve fibers or intraoperative facial nerves as much as possible.Our final purpose is to improve the patients’quality of life.

关 键 词：面神经瘤 面瘫 高分辨率CT 磁共振成像 手术 

分 类 号：R764.433[医药卫生—耳鼻咽喉科]