面神经减压术治疗贝尔面瘫和亨特综合征效果分析  

Effect analysis of facial nerve decompression surgery in the treatment of Bell's palsy and Hunt syndrome

作　　者：王璞 张文阳 王咏峰[2] 夏寅[1] WANG Pu;ZHANG Wenyang;WANG Yongfeng;XIA Yin(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tiantan Hospital,Capital Medical University,Beijing,100070,China;Department of Otorhinolaryngology Head and Neck Surgery,First Affiliated Hospital of Xinjiang Medical University Changji Branch)

机构地区：[1]首都医科大学附属北京天坛医院耳鼻咽喉头颈外科,北京100070 [2]新疆医科大学第一附属医院昌吉分院耳鼻咽喉头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第5期391-394,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：北京市自然科学基金青年项目(No:7234361)。

摘　　要：目的:总结分析面神经减压术治疗贝尔面瘫和亨特综合征的效果。方法:回顾性分析2015年10月至2022年10月接受面神经减压术治疗的65例面神经麻痹患者的临床资料:贝尔面瘫54例,亨特综合征11例;术前评估患者面瘫程度(HB分级)并完成面神经电图(ENoG)、纯音测听、颞骨CT等检查。所有患者接受手术标准均为保守治疗至少1个月效果不佳,HB分级在Ⅳ级以上,ENoG下降超过90%,并且在发病3个月内接受经乳突入路面神经减压术。总结分析贝尔面瘫和亨特综合征两类患者术后面神经功能恢复效果;并且按病程(从发病到手术的间隔时间)分组:A组(发病30~60 d接受手术)15例,B组(发病61~90 d接受手术)50例,探讨手术时机对术后效果的影响。结果:贝尔面瘫患者术后恢复至Ⅰ~Ⅱ级42例(77.8%,42/54),亨特综合征患者术后恢复至Ⅰ~Ⅱ级7例(63.6%,7/11),经χ^(2)检验(P=0.54)两类患者比较差异无统计学意义。按病程分组,A组术后恢复至Ⅰ~Ⅱ级10例(66.7%,10/15);B组术后恢复至Ⅰ~Ⅱ级39例(78.0%,39/50),经χ^(2)检验(P=0.58)2组患者比较差异无统计学意义。结论:贝尔面瘫和亨特综合征患者在发病3个月内接受面神经减压术均可获得良好效果,且两类患者手术效果无显著差异。Objective To summarize and analyze the effect of facial nerve decompression surgery for the treatment of Bell's palsy and Hunt syndrome.Methods The clinical data of 65 patients with facial nerve palsy who underwent facial nerve decompression in our center from October 2015 to October 2022 were retrospectively analyzed,including 54 patients with Bell's palsy and 11 patients with Hunter syndrome.The degree of facial paralysis(HB grade)was evaluated before surgery,and ENoG,pure tone audiometry,temporal bone CT and other examinations were completed.All patients had facial palsy with HB grade V or above after conservative treatment for at least 1 month,and ENoG decreased by more than 90%.All patients underwent facial nerve decompression surgery through the transmastoid approach within 3 months after onset of symptoms.The recovery effect of facial nerve function after surgery in patients with Bell's palsy and Hunter syndrome was summarized and analyzed.In addition,15 cases in group A(operated within 30-60 days after onset)and 50 cases in group B(operated within 61-90 days after onset)were grouped according to the course of the disease(the interval between onset of symptoms and surgery)to explore the effect of surgical timing on postoperative effect.Results There was no significant difference between the two groups of patients with Chi-square test(P=0.54)in 42 patients(77.8%,42/54)with Bell's palsy and 7 patients(63.6%,7/11)in patients with Hunter syndrome who recovered to gradeⅠ-Ⅱ.According to the course of the disease,10 cases(66.7%,10/15)in group A recovered to gradeⅠ-Ⅱafter surgery.In group B,39 patients(78.0%,39/50)recovered to gradeⅠ-Ⅱafter surgery,and there was no statistically significant difference between the two groups by Chi-square test(P=0.58).Conclusion Patients with Bell's palsy and Hunter syndrome can achieve good results after facial nerve decompression within 3 months of onset,and there is no significant difference in the surgical effect between the two types of patients.

关 键 词：贝尔面瘫 亨特综合征 面神经减压术 手术时机 

分 类 号：R745.1[医药卫生—神经病学与精神病学]