不同时机磨除内听道处理大型听神经瘤疗效观察  

Effect of grinding internal auditory canal at different times in the treatment of large acoustic neuroma

作　　者：李超[1] 代兴亮 胡阳春[1] 李志范[1] LI Chao;DAI Xingliang;HU Yangchun;LI Zhifan(Department of Neurosurgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230000)

机构地区：[1]安徽医科大学第一附属医院神经外科合肥,合肥230000

出　　处：《中国神经精神疾病杂志》2021年第11期652-655,共4页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的探讨神经电生理监测下早期内听道磨除在大型听神经瘤显微切除术中的应用价值。方法回顾分析神经电生理监测下行听神经瘤显微切除术的74例患者临床资料。改良组采取术中早期内听道磨除(肿瘤减体积至足够暴露内听道口及后唇时磨除内听道),而传统组采取传统方法内听道磨除(肿瘤主体切除后、切除内听道内肿瘤前磨除内听道),比较两组资料的肿瘤切除程度、切瘤耗时、面神经的解剖保留和功能保留以及围手术期并发症发生率等情况。结果改良组43例,传统组31例,其中肿瘤最大径31~40 mm 42例、>40 mm 32例。改良组、传统组肿瘤全切率(41/43 vs.28/31)差异无统计学意义(χ^(2)=0.72,Ρ=0.40)。改良组平均切瘤耗时(96.32±22.59)min,明显短于传统组(179.06±34.04)min(t=4.39,Ρ=0.04);改良组面神经解剖保留优于传统组,差异有统计学意义(40/43 vs.23/31,χ^(2)=5.05,Ρ=0.03);术后3个月面神经功能(HB I~II级)改良组优于传统组(38/43 vs.21/31,χ^(2)=4.74,Ρ=0.03);改良组术后并发症与传统组差异无统计学意义(5/43 vs.6/31,χ^(2)=0.85,Ρ=0.36)。结论神经电生理监测下早期内听道磨除可有效缩短大型听神经瘤切瘤时间,且能显著提高面神经解剖保留率及功能保留率。Objective To explore the application value of early internal auditory canal grinding unde neuroelectrophysiological monitoring in microsurgical resection of large acoustic neuroma.MethodsThe clinical data of 74 patients with acoustic neuroma undergoing microsurgery under neurophysiological monitoring were analyzed retrospectively.The modified group was treated with early intraoperative internal auditory canal grinding (the interna auditory canal was removed when the tumor volume was reduced to enough exposure of the internal auditory meatus and posterior lip),while the traditional group was served as the control (the internal auditory canal was ground off after the main body of the tumor was removed and before the tumor in the internal auditory canal was removed),the degree of tumo removal,time-consuming of tumor removal,anatomical and functional preservation of facial nerve and the incidence o perioperative complications were compared between the two groups.ResultsThere were 43 cases in the improved group and 31 cases in the traditional group,including 42 cases with maximum tumor diameter D (31~40 mm) and 32 cases (>40 mm)There was no significant difference in the total tumor resection rate between the improved group and the traditional group(41/43 vs.28/31)(χ^(2)=0.72、P=0.40).The average time of tumor resection in the improved group was (96.32±22.59) min which was significantly shorter than that in the traditional group (179.06±34.04) min (t=4.39,P=0.04).The improved group of facial nerve anatomy preservation was better than the traditional group (40/43 vs.23/31,χ^(2)=5.05、P=0.03),and the improved group of facial nerve function (HB I~II) three months after operation was better than the traditional group(38/43 vs.21/31,χ^(2)=4.74、P=0.03).There was no significant difference in postoperative complications between the modified group and the traditional group (5/43 vs.6/31,χ^(2)=0.85、P=0.36).ConclusionsEarly internal auditory cana grinding under the monitoring of neuroelectrophysiology can effectively

关 键 词：听神经瘤 神经电生理 面神经 内听道 

分 类 号：R651.1[医药卫生—外科学]