【摘要】：目的通過(guò)不同方式半規(guī)管阻塞術(shù)治療頑固性梅尼埃病的臨床觀察及療效分析,對(duì)比分析不同阻塞方法對(duì)眩暈的控制及聽(tīng)力保留率,為梅尼埃病的個(gè)體化最佳治療方案的選擇提供依據(jù)。方法回顧性分析2010年12月至2016年1月我院328例行半規(guī)管阻塞術(shù)的梅尼埃病患者的臨床資料。參照梅尼埃病的診斷依據(jù)和療效評(píng)估(2006年,貴陽(yáng))標(biāo)準(zhǔn),所有患者均臨床診斷為單側(cè)梅尼埃病,行規(guī)范化藥物保守治療至少1年以上,但眩暈仍反復(fù)發(fā)作。其中三個(gè)半規(guī)管阻塞術(shù)302例,兩個(gè)半規(guī)管阻塞術(shù)21例,包括水平半規(guī)管聯(lián)合后半規(guī)管阻塞15例,水平半規(guī)管聯(lián)合上半規(guī)管阻塞6例;一個(gè)半規(guī)管阻塞術(shù)5例,均為水平半規(guī)管阻塞。采用純音測(cè)聽(tīng)、前庭雙溫試驗(yàn)和頸源性前庭誘發(fā)肌源性電位(cervical vestibular evokedmyogenic potential,c VEMP)進(jìn)行聽(tīng)力學(xué)和前庭功能評(píng)估,通過(guò)內(nèi)耳MRI膜迷路水成像觀察阻塞術(shù)后膜迷路的形態(tài)學(xué)改變。結(jié)果三個(gè)半規(guī)管阻塞術(shù)對(duì)眩暈控制的總有效率為98.0%(296/302),A級(jí)81.8%(247/302),B級(jí)16.2%(49/302),聽(tīng)力保留率70.2%(212/302);兩個(gè)半規(guī)管阻塞術(shù)對(duì)眩暈控制的總有效率為85.7%(18/21),A級(jí)61.9%(13/21),B級(jí)23.8%(5/21),聽(tīng)力保留率76.2%(16/21);一個(gè)半規(guī)管阻塞對(duì)眩暈控制的總有效率為60.0%(3/5),A級(jí)40.0%(2/5),B級(jí)20.0%(1/5),聽(tīng)力保留率80.0%(4/5)。三個(gè)半規(guī)管阻塞術(shù)眩暈控制有效率高于兩個(gè)半規(guī)管阻塞或一個(gè)半規(guī)管阻塞術(shù)(P0.05)。聽(tīng)力保留率三組之間無(wú)明顯差異(P0.05)。結(jié)論半規(guī)管阻塞術(shù)是治療頑固性梅尼埃病的有效方法。三個(gè)半規(guī)管阻塞術(shù)眩暈控制有效率最高。
[Abstract]:Objective to analyze the clinical observation and curative effect of different methods of semicircular canal occlusion in the treatment of refractory Meniere's disease, and to compare the control of dizziness and the rate of hearing retention with different methods of obstruction. To provide the basis for the selection of the best individualized treatment for Meniere's disease. Methods the clinical data of 328 patients with Meniere's disease undergoing semicircular canal occlusion from December 2010 to January 2016 were retrospectively analyzed. According to the criteria of diagnosis and curative effect evaluation of Meniere's disease (2006, Guiyang), all the patients were diagnosed as unilateral Meniere's disease clinically and treated with standardized medicine conservative therapy for at least one year, but the vertigo still recurred repeatedly. Three semicircular canal occlusion in 302 cases, two semicircular canal occlusion in 21 cases, including horizontal semicircular canal combined with posterior semicircular canal occlusion in 15 cases, horizontal semicircular canal combined with upper semicircular canal obstruction in 6 cases. There were 5 cases of semicircular canal obstruction, all of which were horizontal semicircular canal obstruction. Pure tone audiometry, vestibular double temperature test and cervical vestibular evoked myogenic potential (cervical vestibular evokedmyogenic potential,c VEMP) were used to evaluate audiology and vestibular function. Morphological changes of membranous labyrinth after occlusion were observed by MRI membrane labyrinth water imaging of inner ear. Results the total effective rate of three semicircular canal occlusion for vertigo control was 98.0% (296 / 302), A, 81.8%) (247 / 302), B 16.2%, 49 / 302), and the hearing retention rate was 70.2% (212 / 302). The total effective rate of two semicircular canal occlusion for controlling vertigo was 85.7% (18 / 21), A, 61.9%, 13 / 21), B, 23.8%, 5 / 21), and the hearing retention rate was 76.2% (16 / 21). The total effective rate of semicircular canal obstruction for vertigo control was 60.0% (3 / 5), A 40.0%) (2 / 5), B 20.0% (1 / 5), and the hearing retention rate was 80.0% (4 / 5). The vertigo control efficiency of three semicircular canal occlusion was higher than that of two semicircular canal occlusion or semicircular canal occlusion (P0.05). There was no significant difference in hearing retention rate among the three groups (P0.05). Conclusion semicircular canal occlusion is an effective method for the treatment of refractory Meniere disease. Three semicircular canaliculi occlusion of vertigo control efficiency is the highest.
【作者單位】： 山東大學(xué)附屬省立醫(yī)院耳鼻咽喉頭頸外科 山東省立醫(yī)院集團(tuán)眼耳鼻喉醫(yī)院耳鼻咽喉頭頸外科山東省聽(tīng)力重建重點(diǎn)實(shí)驗(yàn)室;
【基金】：國(guó)家自然科學(xué)基金(81200744) 山東省科技發(fā)展計(jì)劃項(xiàng)目(2011GGH21839)~~
【分類號(hào)】：R764.9

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