【摘要】：目的探討內(nèi)鏡在迷路后進路手術(shù)中的臨床應(yīng)用價值。方法回顧性分析2010年1月至2016年1月收治的32例側(cè)顱底患者的臨床病例資料,男19例,女13例,年齡35-69歲,其中顱神經(jīng)疾病27例(梅尼埃病20例,面肌痙攣5例,三叉神經(jīng)痛2例),橋小腦角膽脂瘤3例,聽神經(jīng)瘤2例。所有病例均采用內(nèi)鏡輔助下迷路后進路完成,術(shù)后均隨訪1~5年,對手術(shù)效果進行分析。結(jié)果 27例顱神經(jīng)病變患者術(shù)后癥狀均消失,其中20例梅尼�；颊咝星巴ド窠�(jīng)切斷術(shù),術(shù)后眩暈控制率100%;5例面肌痙攣患者行面神經(jīng)微血管減壓術(shù),術(shù)后面部痙攣癥狀完全緩解;2例三叉神經(jīng)痛患者行三叉神經(jīng)微血管減壓術(shù),術(shù)后疼痛癥狀消失。以上27例顱神經(jīng)病變患者的術(shù)后面神經(jīng)功能良好,所有病例聽力與術(shù)前相比均無明顯下降,無并發(fā)癥,隨訪1-5年,無復(fù)發(fā)。3例橋小腦角膽脂瘤患者,膽脂瘤均徹底切除,術(shù)后無一例出現(xiàn)面神經(jīng)麻痹或其他顱腦并發(fā)癥,術(shù)后1例患者出現(xiàn)聽力喪失,2例保存實用聽力,隨訪1-5年,膽脂瘤無復(fù)發(fā)。2例聽神經(jīng)瘤患者腫瘤均全切除,術(shù)后均保存實用聽力,無一例出現(xiàn)面神經(jīng)麻痹或其他顱腦并發(fā)癥,隨訪1-5年,腫瘤無復(fù)發(fā)。結(jié)論內(nèi)鏡輔助的迷路后進路,在功能性顱神經(jīng)手術(shù)中具有良好的應(yīng)用價值,能夠清晰顯露責(zé)任血管和V~XI顱神經(jīng),手術(shù)效果好;在橋小腦角膽脂瘤及聽神經(jīng)瘤手術(shù)中,內(nèi)鏡可以多角度無死角地觀察,并做到微創(chuàng)全切除病變。
[Abstract]:Objective to evaluate the clinical value of endoscopy in posterior labyrinthine approach. Methods the clinical data of 32 patients with lateral skull base admitted from January 2010 to January 2016 were retrospectively analyzed. There were 19 males and 13 females aged 35-69 years. Among them, 27 cases were cranial neuropathy (Meniere's disease 20 cases, hemifacial spasm 5 cases). Trigeminal neuralgia (n = 2), cholesteatoma of cerebellopontine angle (n = 3) and acoustic neuroma (n = 2). All cases were treated by endoscope assisted posterior labyrinthine approach. All patients were followed up for 1 ~ 5 years. Results the symptoms of 27 patients with cranial neuropathy disappeared after operation. Twenty patients with Meniere underwent vestibular neurotomy, and the control rate of vertigo was 100%. Facial microvascular decompression was performed in 5 patients with hemifacial spasm, and the symptoms of facial spasm were completely relieved in 2 patients with trigeminal neuralgia. The facial nerve function of 27 patients with craniocerebral neuropathy was good after operation. The hearing of all the patients had no significant decrease and no complications. The follow-up for 1-5 years showed no recurrence. 3 cases of cholesteatoma of cerebellopontine angle were completely resected from cholesteatoma. No facial nerve palsy or other craniocerebral complications occurred after operation, 1 patient had hearing loss, 2 patients had practical hearing preservation, and there was no recurrence of cholesteatoma after follow-up for 1 to 5 years. The tumors of 2 patients with acoustic neuroma were completely resected. No facial paralysis or other craniocerebral complications were found in all cases, and no recurrence was found during the follow-up period of 1 to 5 years. Conclusion Endoscope-assisted posterior labyrinthine approach has good application value in functional cranial nerve surgery and can clearly expose the responsible blood vessel and V~XI cranial nerve. In the operation of cholesteatoma and acoustic neuroma of cerebellopontine angle, endoscopy can be observed in multiple angles without dead angle, and minimally invasive total excision of lesions is achieved.
【作者單位】： 鄭州大學(xué)第一附屬醫(yī)院耳科;上海交通醫(yī)學(xué)院附屬第九人民醫(yī)院耳鼻咽喉頭頸外科;上海交通大學(xué)醫(yī)學(xué)院耳科研究所;上海耳鼻疾病轉(zhuǎn)化醫(yī)學(xué)重點實驗室;
【基金】：國家自然科學(xué)基金面上項目(81470681,81570906,81670919,82371086)~~
【分類號】：R764.9
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本文編號：2357636