难治性梅尼埃病术后眩晕控制情况及再发原因浅谈  

Postoperative Vertigo Control in Intractable Meniere’s Disease and Potential Causes for Recurrence of Vertigo

作　　者：王海霞 林果 郑金秀[1] 陈曦[1] WANG Haixia;LIN Guo;ZHENG Jinxiu;CHEN Xi(Department of Otolaryngology-Head and Neck Surgery,Affiliated People’s Hospital,Fujian University of Traditional Chinese Medicine;Fujian University of Traditional Chinese Medicine)

机构地区：[1]福建中医药大学附属人民医院耳鼻喉科,福建350000 [2]福建中医药大学,福建350000

出　　处：《中华耳科学杂志》2023年第1期16-21,共6页Chinese Journal of Otology

摘　　要：目的 通过分析难治性梅尼埃病患者术后眩晕状态,浅谈难治性梅尼埃病术后眩晕再发的可能原因。方法 回顾性分析2017年1月1日-2020年12月31日就诊于福建中医药大学附属人民医院、并行3个半规管阻塞术+内淋巴囊减压术的16例难治性梅尼埃病患者的临床资料,调查患者术前术后眩晕发作情况、严重程度及其对生活的影响。结果 16例患者术后均出现眩晕及活动后不稳感,2周内均消退。14例患者(87.5%)在术后3个月内存在发作性头晕。随访期间,共有12例患者(75%)诉存在头昏、走路不稳感。术后眩晕发作次数控制程度:A级13例(81.25%),B级1例(6.25%),C级2例(12.5%),眩晕控制总有效率87.5%(14/16)。术后眩晕发作的严重程度及对日常生活的影响:0级4人(25%),1级12人(75%)。病例9术后出现眩晕再发,结合病史及相关检查考虑双侧梅尼埃病。病例8和病例16术后眩晕再发考虑梅尼埃病复发。病例13术后出现头痛及发作性不稳感。尚存在其他不典型眩晕发作形式。结论 本研究中2种术式联合治疗难治性梅尼埃病远期疗效较确切;术后眩晕再发可能与双侧梅尼埃病、半规管的不完全堵塞或再通及前庭性偏头痛的伴发有关,部分不典型的眩晕发作可能与梅尼埃病发病机制及2个术式控制眩晕机制相关,具体尚待进一步研究。Objective To report postoperative vertigo in patients with intractable Meniere’s disease and discuss possible causes for recurrence of vertigo. Methods Patients with refractory Meniere’s disease(n=16) who underwent three semicircular canal occlusion combined subsequent endolymphatic sac decompression at the Department of Otolaryngology-Head and Neck Surgery, Affiliated People’s Hospital, Fujian University of Traditional Chinese Medicine from January 1, 2017 to Dec 31, 2020, were included. Pre-and post-operative vertigo attacks, severity and impact on life were analyzed. Results All 16 patients had vertigo and instability immediately after operation, which disappeared within 2weeks, with 14(87.5%) experiencing paroxysmal dizziness up to 3 months. During follow-up, 12 patients(75%) complained of dizziness and instability when walking. Vertigo was effectively controlled in 14 cases(87.5%), completely resolved in 13(81.25%), substantially improved in 1(6.25%), and partially improved in 2(12.5%). The severity of postoperative vertigo attack and its impact on daily life was at 0 in 4 cases(25%) and 1 in 12 cases(75%). In case 9, postoperative vertigo recurrence was attributed to bilateral Meniere’s disease based on medical history and relevant examinations.Recurrence of Meniere’s disease was thought to be the cause for recurrent dizziness after operation in cases 8 and 16.Postoperative headaches and paroxysmal instability were observed in Case 13. Other atypical forms of vertigo were also observed. Conclusion Definite long-term effects of semicircular canal occlusion combined with endolymphatic sac decompression in the treatment of refractory Meniere’s disease were observed. Postperative vertigo recurrence may be related to bilateral Meniere’s disease, incomplete occlusion or ossification of semicircular canal as well as concomitant vestibular migraine. Atypical vertigo attacks may be related to the pathogenesis of Meniere’s disease and mechanisms of the two surgical techniques in controlling vertigo, a

关 键 词：梅尼埃病 半规管 耳外科手术 眩晕 

分 类 号：R764[医药卫生—耳鼻咽喉科]