CAJ | 학술논문

目的观察半规管阻塞术治疗顽固性梅尼埃病的短期疗效,评价其有效性和安全性.方法回顾性分析17例行半规管阻塞手术的梅尼埃病患者资料,均为确诊单侧梅尼埃病,行规范化药物保守治疗至少1年以上,眩晕仍反复发作者.全麻下经乳突进路行三个半规管阻塞术,术后随访6～13个月,平均10个月.术前及术后3个月采用纯音测听、冷热试验和前庭诱发的肌源性电位检查( vestibular evoked myogenic potential,VEMP)进行听力学和前庭功能评价.结果 17例梅尼埃病患者,术前按听力进行分期,Ⅱ期(平均听阈25～40 dBHL)2例,Ⅲ期(41～70 dBHL)15例.术后随访期内均无眩晕发作,眩晕控制率为100％ (17/17).同期行内淋巴囊减压术的25例梅尼埃病患者,眩晕控制率为72.0％( 18/25),半规管阻塞术的眩晕控制率高于内淋巴囊减压术(x2=3.87,P＜0.05).术后3个月12例患者纯音平均听阈与术前相比无明显变化,5例听阈提高,但均小于20 dBHL,听力下降率29.4％ (5/17).术后所有患者均出现短时间眩晕及平衡障碍,眩晕均在术后3d内消失,10例患者术后1～2周内恢复平衡功能,7例患者术后2个月内平衡障碍完全消失,平衡恢复时间平均12.6d.术后3个月复查,全部病例冷热试验均提示半规管功能丧失,VEMP检查示球囊功能无变化.所有患者均无面神经麻痹、脑脊液漏等并发症发生.结论半规管阻塞术治疗顽固性梅尼埃病短期疗效确切,听力保留率高,不影响耳石器功能,无严重并发症,有望成为治疗存在中度以上听力损失的顽固性梅尼埃病患者安全有效的手术方法.
목적 관찰반규관조새술치료완고성매니애병적단기료효,평개기유효성화안전성.방법 회고성분석17례행반규관조새수술적매니애병환자자료,균위학진단측매니애병,행규범화약물보수치료지소1년이상,현훈잉반복발작자.전마하경유돌진로행삼개반규관조새술,술후수방6～13개월,평균10개월.술전급술후3개월채용순음측은、랭열시험화전정유발적기원성전위검사( vestibular evoked myogenic potential,VEMP)진행은역학화전정공능평개.결과 17례매니애병환자,술전안은력진행분기,Ⅱ기(평균은역25～40 dBHL)2례,Ⅲ기(41～70 dBHL)15례.술후수방기내균무현훈발작,현훈공제솔위100％ (17/17).동기행내림파낭감압술적25례매니애병환자,현훈공제솔위72.0％( 18/25),반규관조새술적현훈공제솔고우내림파낭감압술(x2=3.87,P＜0.05).술후3개월12례환자순음평균은역여술전상비무명현변화,5례은역제고,단균소우20 dBHL,은력하강솔29.4％ (5/17).술후소유환자균출현단시간현훈급평형장애,현훈균재술후3d내소실,10례환자술후1～2주내회복평형공능,7례환자술후2개월내평형장애완전소실,평형회복시간평균12.6d.술후3개월복사,전부병례랭열시험균제시반규관공능상실,VEMP검사시구낭공능무변화.소유환자균무면신경마비、뇌척액루등병발증발생.결론 반규관조새술치료완고성매니애병단기료효학절,은력보류솔고,불영향이석기공능,무엄중병발증,유망성위치료존재중도이상은력손실적완고성매니애병환자안전유효적수술방법.
Objective To investigate the short-term efficacy and safety of triple semicircular canal occlusion (TSCO) in the treatment of intractable Meniere's disease ( MD),so as to provide an alternative surgical procedure for treating MD.Methods Seventeen patients,who had received standardized conservative treatment for at least one year with poor effect,underwent TSCO were retrospectively analyzed.Vertigo control and auditory function were evaluated.Pure tone audiometry,caloric test,and vestibular evoked myogenic potential (VEMP) were performed for evaluation of audiological and vestibular function.Postoperative follow-up period was 6-13 months,with an average of ten months.Results According to the preoperative staging of hearing,among the 17 patients,there were 2 cases in stage Ⅱ ( with an average hearing threshold of 25-40 dBHL) and 15 in stage Ⅲ (41-70 dBHL).No vertigo was found during the follow-up period,with 100％ control rate of vertigo.During the same period,we had performed endolymphatic sac decompression operation in 25 MD patients.The control rate of vertigo was 72.0％.The vertigo control rate of TSCO was significantly higher than that of endolymphatic sac decompression operation ( x2 =3.87,P ＜0.05 ).Three months after surgery,12 patients showed no significant change in comparison to primary status,5 patients presented with an mild increase in the average hearing threshold of less than 20dBHL,with 29.4％ of hearing loss rate.Post-operatively,all patients suffered from temporary vertigo and balance disorders.Vertigo was disappeared in all patients within 3 days,while,balance disorders were disappeared in 10 patients within 1-2 weeks after surgery,and in another 7 patients within 2 months,with an average recovery time of 12.6 days.Three months after treatment,loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in VEMP test was noted.All patients had no facial paralysis,cerebrospinal fluid leakage,and other complications.Conclusions TSCO,which can reduce vertiginous symptoms in patients with intractable MD,represents an effective and safe therapy for this disorder.TSCO is expected to be used as an alternative procedure for the treatment of MD in selected patients suffering from moderate to severe hearing loss.