联合应用内淋巴囊减压和局部激素治疗难治性梅尼埃病的短期与长期疗效分析  

Short-term and long-term outcomes of endolymphatic sac decompression with instillation of local steroids for intractable Meniere's disease

作　　者：许嘉 李欣 陈雯婧 高娟娟 卢星星 伊海金 XU Jia;LI Xin;CHEN Wenjing;GAO Juanjuan;LU Xingxing;YI Haijin(Department of Otorhinolaryngology&Head and Neck Surgery,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院/清华大学医学院耳鼻咽喉头颈外科,北京102218

出　　处：《山东大学耳鼻喉眼学报》2022年第4期17-21,共5页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：北京清华长庚医院研究基金(12019C1002;12021C6009)。

摘　　要：目的探讨内淋巴囊减压联合经面隐窝鼓室内激素注射以及内淋巴囊表面覆盖激素明胶海绵治疗难治性梅尼埃病的短期与长期临床效果。方法回顾分析针对难治性梅尼埃病进行手术治疗的23例患者资料。手术方式在传统内淋巴囊减压的基础上,开放面隐窝,并在圆窗周围放置明胶海绵,鼓室内注射激素,同时在内淋巴囊表面放置明胶海绵并在乳突内注射激素。比较患者治疗前6个月与术后6~12个月(短期疗效),以及术后18~24个月(长期疗效)的眩晕发作次数以及平均听阈水平(500、1000、2000 Hz)。结果23例患者完成短期疗效评价,术后眩晕发作次数由(5.7±5.9)次(术前6个月)降至(0.4±1.0)次(术后6~12个月),眩晕控制率为87.0%。术后听力维持率为95.7%。13例患者完成长期疗效评价,术后眩晕发作次数由(4.2±2.6)次(术前6个月)降至(0.1±0.3)次(术后18~24个月),眩晕控制率为92.3%,术后听力维持率为100%。结论内淋巴囊减压联合局部激素治疗对于保守治疗无效的难治性梅尼埃病具有良好的眩晕控制率和听力维持率,值得推广。Objective To investigate the short-term and long-term effects of endolymphatic sac decompression with instillation of local steroids for intractable Meniere's disease.Methods Twenty-three patients who underwent surgery for intractable Meniere's disease were enrolled.The surgical strategy included traditional endolymphatic sac decompression,opening of the facial recess,placement of gelatin sponge around the round window,and injection of steroids into the tympanic cavity and onto the surface of the endolymphatic sac.Frequency of vertigo episodes and hearing function(pure tone averages)were compared before surgery,6~12 months after surgery,and 18~24 months after surgery.Results Twenty-three patients completed the short-term effect evaluation at 12 months after surgery.The frequency of vertigo episodes decreased from(5.7±5.9)to(0.4±1.0)times.The vertigo control rate was 87.0%,while the hearing maintenance rate was 95.7%.Thirteen patients completed the long-term effect evaluation at 24 months after surgery.The frequency of vertigo episodes decreased from(4.2±2.6)to(0.1±0.3)times.The vertigo control rate was 92.3%,while the hearing maintenance rate was 100%.Conclusion Endolymphatic sac decompression with instillation of local steroids for the treatment of intractable Meniere's disease had favorable effects on vertigo control and the maintenance of hearing function.

关 键 词：梅尼埃病 内淋巴囊减压术 鼓室内注射激素 眩晕 听力下降 

分 类 号：R764.33[医药卫生—耳鼻咽喉科]