听神经瘤乙状窦后入路手术后迟发性面瘫影响因素分析  

Analysis of influencing factors of delayed facial paralysis after retrosigmoid approach surgery for vestibular schwannoma

作　　者：朱旭强[1] 焦贺男 李雪元 吴力新[1] 马斯奇[1] 闫东明[1] ZHU Xu-qiang;JIAO He-nan;LI Xue-yuan;WU Li-xin;MA Si-qi;YAN Dong-ming(Department of Neurosurgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,He'nan,China)

机构地区：[1]郑州大学第一附属医院神经外科,450052

出　　处：《中国现代神经疾病杂志》2022年第12期1041-1046,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的总结听神经瘤手术后迟发性面瘫发生特点并筛查相关影响因素。方法纳入2019年1月至2021年5月郑州大学第一附属医院诊断与治疗的171例听神经瘤患者,均于神经电生理监测下行乙状窦后入路手术,手术前后采用面神经功能House-Brackmann(H-B)分级进行面瘫分级,单因素和多因素前进法Logistic回归分析筛查听神经瘤手术后迟发性面瘫相关危险因素。结果根据术后是否发生迟发性面瘫分为迟发性面瘫组(DFP组,19例)和非迟发性面瘫组(NDFP组,152例),DFP组肿瘤直径小于NDFP组(t=6.623,P=0.001)、小瘤体比例(χ^(2)=18.585,P=0.000)及肿瘤与面神经轻度粘连比例(χ^(2)=21.442,P=0.000)均高于NDFP组。Logistic回归分析显示,小瘤体(OR=15.797,95%CI:3.324~75.081;P=0.001)及肿瘤与面神经轻度粘连(OR=11.690,95%CI:3.413~40.042;P=0.000)是听神经瘤手术后迟发性面瘫的危险因素。随访至术后1年,19例迟发性面瘫患者中17例面神经功能正常或接近正常(H-B分级Ⅰ~Ⅱ级)。结论肿瘤体积较小以及肿瘤与面神经轻度粘连的患者术后易发生迟发性面瘫,此类患者面神经功能预后良好。Objective To summarize the characteristics of delayed facial paralysis(DFP)after retrosigmoid approach surgery for vestibular schwannoma and screen its related influencing factors.Methods A total of 171 patients with vestibular schwannoma treated in The First Affiliated Hospital of Zhengzhou University from January 2019 to May 2021 were included in the study.All patients underwent retrosigmoid approach surgery under neuroelectrophysiological monitoring.Before and after the surgery,facial paralysis was classified according to House-Brackmann(H-B)grade of facial nerve function.Univariate and multivariate forward Logistic regression analysis was used to screen related risk factors of DFP after vestibular schwannoma surgery.Results Patients were divided into DFP group(n=19)and non-DFP(NDFP)group(n=152)according to whether there was DFP after surgery.The tumor diameter in DFP group was smaller than that in NDFP group(t=6.623,P=0.001),the proportion of small tumors(χ^(2)=18.585,P=0.000)and the proportion of slight adhesion between tumor and facial nerve(χ^(2)=21.442,P=0.000)were higher than those in NDFP group.Logistic regression analysis showed small tumor(OR=15.797,95%CI:3.324-75.081;P=0.001)and slight adhesion between tumor and facial nerve(OR=11.690,95%CI:3.413-40.042;P=0.000)were risk factors for DFP after vestibular schwannoma surgery.Following up to one year after surgery,the recovery rate of facial nerve function(H-B gradeⅠ-Ⅱ)in DFP group was 17/19.Conclusions The patients with small tumor volume and slight adhesion between tumor and facial nerve are prone to DFP,and the prognosis of facial nerve function in such patients is good.

关 键 词：神经瘤 听 显微外科手术 面神经麻痹 手术后并发症 危险因素 LOGISTIC模型 

分 类 号：R739.41[医药卫生—肿瘤]