舌下神经-面神经吻合术治疗小脑脑桥角区病变切除术后周围性面瘫的效果分析  

Efficacy analysis of hypoglossal-facial nerve anastomosis in the treatment of peripheral facial paralysis after resection of lesions in cerebellopontine angle

作　　者：郑玄 马珩钞 陈桂琳 史旭东 张泽瀚 陶丙岩 李翀[1] 张军[1] Zheng Xuan;Ma Hengchao;Chen Guilin;Shi Xudong;Zhang Zehan;Tao Bingyan;Li Chong;Zhang Jun(Department of Neurosurgery,the First Medical Centre,Chinese PLA General Hospital,Beijing 100853,China;Medical School of Chinese PLA,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心神经外科医学部,北京100853 [2]解放军医学院,北京100853

出　　处：《中华神经外科杂志》2023年第8期794-798,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨舌下神经一面神经吻合术治疗小脑脑桥角区病变手术相关周围性面瘫的效果和安全性。方法回顾性分析2011年7月至2022年3月于解放军总医院第一医学中心神经外科医学部收治的37例小脑脑桥角区病变切除术后周围性面瘫患者的临床资料。所有患者均行舌下神经-面神经端-端吻合术治疗。患者术前及术后的面神经功能采用House-Brackmann(H-B)分级评估,观察吻合术后的并发症情况。术前H-B分级V级者3例,Ⅵ级者34例。探讨影响患者吻合术后面神经功能恢复情况的因素。结果术后12个月随访时,H-B分级Ⅰ级者4例,Ⅲ级者29例,Ⅳ级者3例,Ⅴ级者1例。手术有效(术后面神经功能恢复至H-B分级I~Ⅲ级)率为89.2%(33/37)。患者术后的面神经功能恢复情况与面瘫病程有关(P=0.001),而与性别、年龄、术前H-B分级无关(均P>0.05)。术后12个月随访时,无一例出现明显的构音障碍或吞咽困难等严重并发症。结论对于小脑脑桥角区病变切除术后的周围性面瘫,舌下神经一面神经端-端吻合术为有效Ⅰ的治疗方法,且并发症较轻。面瘫病程6个月的患者吻合术后的面神经功能恢复较好。Objective To investigate the efficacy and safety of hypoglossal-facial nerve anastomosis in the treatment of peripheral facial paralysis associated with surgery for cerebellopontine angle lesions.Methods A retrospective analysis was conducted on the clinical data of 37 patients with peripheral facial paralysis after resection of cerebellopontine angle lesions who were admitted to the Department of Neurosurgery,the First Medical Centre,Chinese PLA General Hospital from July 2011 to March 2022.All patients underwent hypoglossal-facial nerve end-to-end anastomosis.The facial nerve function of patients before and after operation was evaluated by House-Brackmann(H-B)grading system and the complications after anastomosis were documented.There were 3 cases of H-B grade Ⅴ and 34 cases of H-B grade Ⅵ before operation.We also explored the factors affecting the recovery of facial nerve function in patients.Results At 12 months post operation,H-B grade Ⅱ was reported in 4 cases,grade II in 29 cases,grade IV in 3 cases and grade V in 1 case.The rate of effectiveness(defined as postoperative H-B grade of Ⅰ-Ⅱ)was 89.2%(33/37).The recovery of facial nerve function was related to the course of facial paralysis(P=0.001),which it had no correlation with the patient's gender,age or preoperative H-B grade(all P>0.05).At 12-month follow-up post operation,there were no significant complications such as dysarthria or dysphagia.Conclusions Hypoglossal-facial nerve end-to-end anastomosis is an effective method for peripheral facial paralysis after resection of cerebellopontine angle lesions and the complications seem mild.Patients with facial paralysis lasting for≤6 months may have better facial nerve function recovery after anastomosis.

关 键 词：面神经麻痹 神经外科手术 治疗结果 舌下神经-面神经吻合术 影响因素分析 

分 类 号：R651.3[医药卫生—外科学]