本文關(guān)鍵詞： 巖部膽脂瘤 耳外科手術(shù) 面神經(jīng)麻痹　出處：《中華耳科學(xué)雜志》2014年03期 　論文類型：期刊論文

【摘要】：目的分析總結(jié)顳骨巖部膽脂瘤的外科治療、術(shù)中面神經(jīng)功能的保護及修復(fù)方法及療效。方法回顧性分析解放軍總醫(yī)院2000年1月至2012年12月79例手術(shù)治療的顳骨巖部膽脂瘤病例,按House-Brackmann法對面神經(jīng)功能進行分級,根據(jù)術(shù)中探查所見,依據(jù)面神經(jīng)損傷的部位和范圍分別采用面神經(jīng)減壓、吻合、耳大神經(jīng)移植、面神經(jīng)-舌下神經(jīng)吻合術(shù)等方法進行修復(fù);隨診1年以上,資料齊全的48例患者,根據(jù)手術(shù)前后面神經(jīng)功能的分級進行比較,分析治療效果。結(jié)果 79例巖部膽脂瘤患者經(jīng)過手術(shù)切除病灶,術(shù)中發(fā)現(xiàn)面神經(jīng)受累部位以迷路段最為多見。面神經(jīng)損傷修復(fù)方法:面神經(jīng)減壓48例(60.76%);面神經(jīng)端端吻合5例(6.33%);面神經(jīng)改道吻合3例(3.80%);耳大神經(jīng)移植修復(fù)面神經(jīng)3例(3.80%);面神經(jīng)舌下神經(jīng)吻合10例(12.66%)。剩余10例術(shù)中面神經(jīng)未處理。隨訪1年以上,資料完整的48例患者預(yù)后:面神經(jīng)減壓:29例,術(shù)前面神經(jīng)功能Ⅰ級13例,Ⅱ級1例,Ⅲ級7例,Ⅳ級2例,Ⅴ級4例,Ⅵ級2例;術(shù)后Ⅰ級22例,Ⅱ級2例,Ⅲ級1例,Ⅳ級3例,Ⅴ級1例。端端吻合:4例;術(shù)前Ⅰ級1例,Ⅴ級3例;術(shù)后Ⅱ級1例,Ⅲ級3例。改道吻合:3例;術(shù)前Ⅴ級1例,Ⅵ級2例;術(shù)后:Ⅲ級2例,Ⅳ級1例。耳大神經(jīng)移植:2例;術(shù)前均為Ⅴ級;術(shù)后:Ⅳ級1例,Ⅴ級1例。面神經(jīng)舌下神經(jīng)吻合術(shù):7例;術(shù)前Ⅴ級4例,Ⅵ級3例;術(shù)后:Ⅲ級1例,Ⅳ級4例,Ⅴ級2例。3例術(shù)中未處理面神經(jīng)病例,面神經(jīng)功能無變化。結(jié)論顳骨巖部膽脂瘤術(shù)中需仔細保護面神經(jīng),發(fā)現(xiàn)面神經(jīng)損傷后應(yīng)及時修復(fù),依據(jù)損傷程度和范圍的不同,采取不同的修復(fù)方式可以使患者獲得較好的預(yù)后效果。
[Abstract]:Objective to summarize the surgical treatment of petrosal cholesteatoma in temporal bone. Methods from January 2000 to December 2012, 79 cases of cholesteatoma in the petrosal region of temporal bone treated in PLA General Hospital were retrospectively analyzed. The facial nerve function was classified according to House-Brackmann method. According to the findings of intraoperative exploration, facial nerve decompression, anastomosis and great auricular nerve transplantation were used according to the site and scope of facial nerve injury. Facial nerve and hypoglossal nerve anastomosis were repaired. According to the classification of facial nerve function before and after operation, the therapeutic effect was analyzed. Results 79 patients with petrosal cholesteatoma underwent surgical resection. The most common site of facial nerve injury was labyrinth. The repair method of facial nerve injury was: facial nerve decompression in 48 cases (60.76A); End-to-end anastomosis of facial nerve was performed in 5 cases. The facial nerve was changed to anastomosis in 3 cases. The facial nerve was repaired by the transplantation of the great auricular nerve in 3 cases. Facial nerve hypoglossal nerve anastomosis was performed in 10 cases with hypoglossal nerve anastomosis. The remaining 10 cases were not treated during the operation. 48 patients with complete data were followed up for more than one year. 29 cases were decompressed by facial nerve decompression. There were 13 cases of grade 鈪，

本文編號：1464608