内淋巴管夹闭术治疗梅尼埃病的效果  

Efficacy of endolymphatic duct blockage in treating Ménière’s disease

作　　者：杨涛[1,2,3] 张智雯 汪芹 彭安全[1,2] 李葳 YANG Tao;ZHANG Zhiwen;WANG Qin;PENG Anquan;LI Wei(Department of Otolaryngology-Head and Neck Surgery,Second Xiangya Hospital,Central South University,Changsha 410011;Clinical Medical Research Center for Otology in Hunan Province,Changsha 410011;Department of Otolaryngology,Guilin Hospital of Second Xiangya Hospital,Central South University,Guilin Guangxi 541002,China)

机构地区：[1]中南大学湘雅二医院耳鼻咽喉头颈外科,长沙410011 [2]湖南省耳科临床医学研究中心,长沙410011 [3]中南大学湘雅二医院桂林医院耳鼻咽喉科,广西桂林541002

出　　处：《中南大学学报（医学版）》2024年第5期712-720,共9页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(82301326)。

摘　　要：目的:梅尼埃病(Ménière’s disease,MD)是一种特发性的内耳疾病,临床表现为反复的发作性旋转性眩晕、波动性听力下降、耳鸣和耳闷胀感。内淋巴囊相关的手术主要用于药物治疗无效的MD患者。内淋巴管夹闭术(endolymphatic duct blockage,EDB)是一种治疗MD的新术式,相关临床研究较少。本研究旨在探讨MD患者行EDB后内淋巴积水(endolymphatic hydrops,EH)的改变及手术远期疗效,评估不同类型内淋巴囊的手术效果。方法:回顾性分析33例接受EDB治疗的难治性MD患者,根据患者的内淋巴囊形态分为正常形态组(n=14)和萎缩形态组(n=19)。比较2组患者在术前和术后眩晕症状的发作频率、听力、前庭功能和内耳钆增强MRI的变化。结果:与萎缩形态组比较,正常形态组患者具有更高的眩晕完全控制率、更好的耳蜗和前庭功能以及更低的前庭内淋巴间隙体积占前庭总淋巴体积的比值(均P<0.05)。此外,正常形态组共有7例患者出现EH的逆转,而萎缩形态组术后未检测到EH的逆转。结论:正常形态和萎缩形态内淋巴囊的MD患者对EDB治疗的反应存在差异,提示2种不同病理类型的内淋巴囊可能存在不同的发病机制。Objective:Ménière’s disease(MD)is an idiopathic inner ear disorder characterized by recurrent episodes of episodic rotational vertigo,fluctuating hearing loss,tinnitus,and a feeling of ear stuffiness.Endolymphatic sac(ES)-related surgery is used primarily in patients with MD who have failed to respond to pharmacologic therapy.Endolymphatic duct blockage(EDB)is a new procedure for the treatment of MD,and related clinical studies are still scarce.This study aims to investigate the dynamic changes in endolymphatic hydrops(EH)and the long-term surgical outcomes in MD patients undergoing EDB,and to evaluate the impact of different types of ES on the surgical efficacy.Methods:A retrospective analysis was conducted on 33 patients with refractory MD who underwent EDB.Based on the morphology of their endolymphatic sacs,patients were divided into a normal-type group(n=14)and an atrophic-type group(n=19).The frequency of vertigo symptoms,hearing,vestibular function,and the dynamic changes of gadolinium-enhanced MRI of the inner ear were compared were compared before and after surgery between the 2 groups.Results:Compared with the atrophic-type group,the patients in the normal-type group had a higher rate of complete vertigo control,better cochlear and vestibular function,and a lower endolymph to vestibule volume ratio(all P<0.05).In addition,7 patients in the normal-type group were found to have reversal of EH,while no reversal of EH was detected in the atrophic-type group after surgery.Conclusion:The response to EDB treatment varies between normal and atrophic MD patients,suggesting that the 2 pathological types of endolymphatic sacs may have different underlying mechanisms of disease.

关 键 词：梅尼埃病 内淋巴管夹闭术 眩晕 内淋巴囊 内淋巴积水 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]