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作 者:温立婷 李旭 高伟 胡田勇 曾宪海 查定军 WEN Liting;LI Xu;GAO Wei;HU Tianyong;ZENG Xianhai;ZHA Dingjun(Department of Otolaryngology,Longgang E.N.T hospital&Shenzhen Key laboratory of E.N.T,Institute of E.N.T,Shenzhen,518172,Guangdong,China;Department of Otorhinlaryngology&Head and Neck Surgery,Xijing Hospital,Air Force Medical University,Xi'an 710032,Shaanxi,China;Department of Otolaryngology,the 984 Hospital of the People's Liberation Army,Beijing 100094,China;Department of Otorhinlaryngology&Head and Neck Surgery,Tangdu Hospital,Air Force Medical University,Xi'an 710038,Shaanxi,China)
机构地区:[1]深圳市龙岗区耳鼻咽喉医院/深圳市耳鼻咽喉研究所耳鼻喉科,广东深圳518172 [2]空军军医大学西京医院耳鼻咽喉头颈外科,陕西西安710032 [3]解放军第九八四医院耳鼻喉科,北京100094 [4]空军军医大学唐都医院耳鼻咽喉头颈外科,陕西西安710038
出 处:《山东大学耳鼻喉眼学报》2022年第5期1-5,共5页Journal of Otolaryngology and Ophthalmology of Shandong University
基 金:深圳市龙岗区经济与科技发展专项资金(LGKCYLWS2021000030);深圳市医学重点学科建设经费资助(SZXK039)。
摘 要:目的 探讨中耳手术后迟发性面瘫出现的可能病因、处理措施及结果。方法 收集自2017年1月至2018年12月接受中耳手术病例资料1 124例,回顾性分析迟发性面瘫发生时间、相关因素、治疗经过及恢复情况。结果 1 124例中耳手术术后出现迟发性面瘫17例,发生率为1.51%;术后3~20 d出现迟发性面瘫,平均(10.00±4.11)d;按照各术式分布如下:鼓室成形术Ⅰ型(8/348,2.30%),鼓室成形术Ⅱ型(4/247,1.62%),开放式乳突切开+鼓室成形术(5/529,0.95%),各术式之间迟发性面瘫发生率差异无统计学意义;按照面神经骨管情况分布如下:面神经骨管部分缺失348例,术后迟发性面瘫(5/348,1.44%),面神经管完整776例,术后迟发性面瘫(12/776,1.55%),面神经骨管是否完整,术后迟发性面瘫发生率差异无统计学意义;1例发生术后术腔感染,细菌培养提示铜绿假单胞菌感染,对症处理感染控制后,行面神经探查、耳大神经切取面神经吻合术,术后1年面神经功能恢复至Ⅲ级;其余16例全部予以激素等保守治疗,治疗后0.5~3个月后功能完全恢复。结论 中耳术后迟发性面瘫与手术方式、面神经是否裸露等因素无关,保守治疗效果好。Objective To explore the causes,treatments,and outcomes of delayed facial paralysis(DFP) after different types of middle ear surgery.Methods A retrospective study was done on the clinical data of 1 124 cases experienced middle ear surgery from January 2017 to December 2018,including onset,risk factors,treatment and rehabilitation of DFP.Results Among the 1 124 patients who underwent middle ear surgery,17(1.51%) presented DFP 3-20 days after surgery,with an average incidence at 10.00±4.11 days.The incidence of DFP after type Ⅰ tympanoplasty,type Ⅱ tympanoplasty,and tympanoplasty with mastoidectomy of the canal wall down were 2.30%,1.62%,and 0.95%,respectively,and the differences were not statistically significant.The incidence of DFP in 776 patients with intact facial canal and 348 with dehiscent facial canal were 1.55% and 1.44%,respectively,and this difference also was not statistically significant.In addition,postoperative infection with Pseudomonas aeruginosa occurred in one of the patients with DFP who was later treated with a great auricular nerve graft and facial nerve anastomosis.The patient’s condition improved to grade Ⅲ a year after surgery.The remaining 16 patients were treated with steroids as conservative management,and their conditions were fully restored after 0.5-3 months.Conclusion The possible cause of DFP following middle ear surgery has nothing to do with surgical approaches and facial canal dehiscence.Notably,conservative management resulted in good outcomes.
关 键 词:迟发性面瘫 中耳 鼓室成形术 开放式乳突切开术 面神经 吻合术
分 类 号:R764.2[医药卫生—耳鼻咽喉科]
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