2种吻合术修复面神经缺损的疗效分析  

Clinical characteristics and prognosis of two anastomosis techniques in the treatment of facial nerve defects

作　　者：范术杭 孙健斌 王琴 塞娜[2] 季琦 朱玉华[2] 申卫东[2] 戴朴[2] 杨仕明[2] 韩东一[2] 韩维举[2] FAN Shuhang;SUN Jianbin;WANG Qin;SAI Na;JI Qi;ZHU Yuhua;SHEN Weidong;DAI Pu;YANG Shiming;HAN Dongyi;HAN Weiju(Medical School of Chinese PLA,Beijing,100853,China;Senior Department of Otolaryngology Head and Neck Surgery,Chinese PLA General Hospital,Chinese PLA Medical School;Liaoning Women and Children's Hospital)

机构地区：[1]解放军医学院,北京100853 [2]中国人民解放军总医院耳鼻咽喉头颈外科医学部、解放军总医院第六医学中心耳鼻咽喉头颈外科医学部 [3]辽宁省妇女儿童医院

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第5期395-399,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家耳鼻咽喉疾病临床医学研究中心开放课题(No:202200007)。

摘　　要：目的:探讨分析2种吻合术修复面神经缺损的疗效及影响因素。方法:回顾性分析2012年1月至2021年12月在我科行面神经吻合术(直接或改道)修复面神经缺损的30例患者临床资料,其中男21例,女9例,平均年龄(37.53±11.33)岁,均为单侧发病;术前H-BⅣ级2例、Ⅴ级9例、Ⅵ级19例;面瘫患者术前面瘫时间6个月以内21例,6~12个月6例,1年以上3例;面瘫原因包括胆脂瘤14例、面神经肿瘤6例、外伤6例、中耳手术损伤4例。手术入路包括颅中窝入路9例,迷路-耳囊入路8例,乳突-上鼓室入路7例,耳后颈侧入路6例。结果:随访2年以上。术中采用直接吻合10例:缺损位于颞骨外段6例,水平-锥段4例;改道吻合20例:缺损位于迷路-膝状神经节11例,内听道至膝状神经节及水平段近端4例,内听道3例,水平-锥段2例。术后H-B面神经评分为Ⅱ级2例、Ⅲ级20例、Ⅳ级8例,73.3%(22/30)患者能达到H-BⅢ级或更好。结论:面神经直接吻合术和改道吻合术均可修复面神经缺损,2种术式疗效无明显差异。多数患者能达到H-BⅢ级或更好。术前面神经功能评级及术前面瘫时间是影响面神经吻合效果的主要影响因素。Objective To investigate the characteristics and prognosis of two anastomosis techniques in repairing facial nerve defects.Methods A retrospective analysis was conducted on 30 patients who underwent facial nerve anastomosis(direct or rerouting)for facial nerve defects in our department from January 2012 to December 2021.Among them,21 were male and 9 were female,with an average age of(37.53±11.33)years,all with unilateral onset.Preoperative House-Brackmann(H-B)facial nerve function grades wereⅣin 2 cases,Ⅴin 9 cases,andⅥin 19 cases.The duration of facial paralysis before surgery was within 6 months in 21 cases,6-12 months in 6 cases,and over 1 year in 3 cases.The causes of facial paralysis included 14 cases of cholesteatoma,6 cases of facial neurioma,6 cases of trauma,and 4 cases of middle ear surgery injury.Surgical approaches included 9 cases of the middle cranial fossa approach,8 cases of labyrinthine-otic approach,7 cases of mastoid-epitympanum approach,and 6 cases of retroauricular lateral neck approach.Results All patients were followed up for more than 2 years.The direct anastomosis was performed in 10 cases:6 cases with defects located in the extratemporal segment and 4 cases in the tympanic segment.Rerouting anastomosis was performed in 20 cases:11 cases with defects located in the labyrinthine-geniculate ganglion,4 cases from the internal auditory canal to the geniculate ganglion,3 cases in the internal auditory canal,and 2 cases in the horizontal-pyramid segment.Postoperative H-B facial nerve grades wereⅡin 2 cases,Ⅲin 20 cases,andⅣin 8 cases,with 73.3%(22/30)of patients achieving H-B gradeⅢor better.Conclusion Both direct and rerouting anastomosis techniques can effectively repair facial nerve defects,with no significant difference in efficacy between the two techniques.Most patients can achieve H-B gradeⅢor better facial nerve function recovery.Preoperative facial nerve function and duration of facial paralysis are the main prognostic factors affecting the outcome of facial nerve anas

关 键 词：面神经缺损 面神经吻合术 周围神经修复 

分 类 号：R745.1[医药卫生—神经病学与精神病学]