内淋巴囊乳突腔分流术中耳蜗电图的变化特征及临床意义  

Characteristics and Significance of ECochG Changes in Endolymphatic Sac Decompression Surgery

作　　者：冯天赐 杨海弟[1] 邓文婷 许耀东[1] 唐小武[1] 陈玲[1] 黄伟洛 区永康[1] FENG Tianci;YANG Haidi;DENG Wenting;XU Yaodong;TANG Xiaowu;CHEN Ling;HUANG Weiluo;QU Yongkang(Department of Otolaryngology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510000,China;不详)

机构地区：[1]中山大学孙逸仙纪念医院耳鼻喉科,广州510000 [2]广州优听电子科技有限公司

出　　处：《中华耳科学杂志》2025年第1期43-48,共6页Chinese Journal of Otology

摘　　要：目的探讨内淋巴囊乳突腔分流术中耳蜗电图(electrocochleagram,ECochG)特征值(幅值比与面积比)的动态变化及临床意义。方法纳入2018年10月至2020年11月中山大学孙逸仙纪念医院收治的单侧梅尼埃病(Ménière's disease,MD)患者37例。所有患者均行内淋巴囊乳突腔分流手术(endolymphatic mastoid shunting,EMS),在术前、乳突开放期、迷路气房切除期、内淋巴囊区及周围骨板去除期、内淋巴囊切开期、插管引流期、关闭术腔期进行ECochG监测。术后随访18月。比较术后与术前纯音测听(pure tone audiometry,PTA)、眩晕发作次数、眩晕发作程度对生活质量影响系数,并对术中不同阶段ECochG幅值比、面积比及术后18月头晕残障问卷(dizziness handicap inventory,DHI)得分、眩晕发作程度对生活质量影响系数、眩晕控制疗效得分情况进行相关性分析。结果术后18月,MD患者PTA与术前比较,差异无统计学意义(P>0.05);DHI评分中功能性分数、情绪性分数、躯体性分数及DHI总分均低于术前,差异有统计学意义(P<0.05);眩晕发作次数A级1例、B级11例、C级16例、D级9例、E级0例;眩晕发作程度低于术前,差异有统计学意义(P<0.05);术中乳突开放期、迷路气房切除期ECochG幅值比、面积比与术前比较,差异均无统计学意义(P>0.05),内淋巴囊区及周围骨板去除、内淋巴囊切开、插管引流、缝合切口关闭术腔期ECochG幅值比、面积比均低于术前,差异均有统计学意义(P<0.05)。术中ECochG幅值比、面积比与术后18月DHI得分、眩晕发作程度评分、眩晕疗效控制评分均呈正相关,差异有统计学意义(P<0.05)。结论EMS能有效减轻MD患者眩晕情况,术中ECochG幅值比、面积比变化对患者术后康复情况具有一定的预测作用。Objective To report changes of indicator cochleography parameters,i.e.SP/AP amplitude and area under curve ratios,and their potential values in endolymphatic sac decompression(endolymphatic mastoid shunt)for Ménière's disease(MD).Methods A total of 37 patients with unilateral MD who underwent endolymphatic mastoid shunting(EMS)at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from October 2018 to November 2020 were included.Electrocochleography was performed before surgery,during mastoidectomy exposure of the endolymphatic sac,endolymphatic sac incision and drainage,and closure of the surgical cavity.Postoperatively,patients were followed-up for 18 months.Pre-and post-operative pure-tone audiometry(PTA),frequency of vertigo attacks and impact of vertigo on quality of life were compared.Additionally,correlation between SP/AP amplitude and area under curve ratios at various surgical stages and the Dizziness Handicap Index(DHI)scores at 18 months post-surgery,coefficient of vertigo impact on quality of life,and vertigo control outcomes were analyzed.Results At 18 months postsurgery,PTA showed no significant difference compared to before surgery(P>0.05);although the functional,emotional,somatic and total DHI scores were lower(P<0.05).The number of vertigo attacks reached Grade A in 1 case,Grade B in 11 cases,Grade C in 16 cases,and Grade D in 9 cases.The severity of vertigo attacks also decreased compared to pre-operation(P<0.05).No significant changes in SP/AP amplitude and area ratios were noticed during mastoidectomy and labyrinth skeletonization(P>0.05),but decreased ratios were noticed during endolymphatic sac exposure,incision and drainage which persisted during closure of the surgical cavity(P<0.05).The SP/AP intraoperative ratios showed a positive correlation with DHI scores at 18 months,severity of vertigo attacks and vertigo control outcomes(P<0.05).Conclusion EMS can effectively alleviate dizziness in MD,and intraoperative changes in SP/AP amplitude and area ratios have a certain predictive

关 键 词：耳蜗电图 梅尼埃病 内淋巴囊乳突腔分流术 术中监测 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]