CAJ | 학술논문

目的：探讨术前面神经电图预测腮腺肿瘤患者面神经受侵状态的可行性。方法：53例腮腺原发性肿瘤患者，其中良性肿瘤28例，恶性肿瘤25例。两组间肿瘤部位及大小相近，术前House-Brackmann （ H-B）面神经功能评分均为Ⅰ级。所有患者行双侧面神经电图检查，结合术中所见及病理检查结果，对比同一患者两侧耳前、耳后刺激时的波幅和潜伏时，进行Wilcoxon符号秩检验和受试者工作特征曲线分析。结果：腮腺良性肿瘤患者，诱发面神经最大动作电位的刺激电流平均为20．0 mA，10．7％患者患侧耳后刺激时面神经的Ⅰ或Ⅱ支无反应波引出，患侧耳后刺激面神经电图的波幅较健侧下降（P＜0．05）。恶性肿瘤患者，诱发面神经最大动作电位的刺激电流平均为24．5 mA，显著高于良性肿瘤患者（ P＝0．001）。36．0％患者患侧耳后刺激时多条面神经分支神经电图无反应波引出，其比例高于良性肿瘤患者（ P＝0．028）。患侧面神经耳后刺激时神经电图的波幅与健侧相比明显降低或无反应波（P＜0．05），潜伏时较健侧延长（P＜0．05）。面神经电图的ROC曲线下面积为0．884。结论：面神经受侵时，诱发面神经最大动作电位的刺激电流强度增高，耳后刺激时面神经电图的波幅较健侧降低，恶性肿瘤患者无反应波引出者的比例增高。无面瘫症状的腮腺肿瘤患者，术前面神经电图检查有助于预测面神经受侵状态。
목적：탐토술전면신경전도예측시선종류환자면신경수침상태적가행성。방법：53례시선원발성종류환자，기중량성종류28례，악성종류25례。량조간종류부위급대소상근，술전House-Brackmann （ H-B）면신경공능평분균위Ⅰ급。소유환자행쌍측면신경전도검사，결합술중소견급병리검사결과，대비동일환자량측이전、이후자격시적파폭화잠복시，진행Wilcoxon부호질검험화수시자공작특정곡선분석。결과：시선량성종류환자，유발면신경최대동작전위적자격전류평균위20．0 mA，10．7％환자환측이후자격시면신경적Ⅰ혹Ⅱ지무반응파인출，환측이후자격면신경전도적파폭교건측하강（P＜0．05）。악성종류환자，유발면신경최대동작전위적자격전류평균위24．5 mA，현저고우량성종류환자（ P＝0．001）。36．0％환자환측이후자격시다조면신경분지신경전도무반응파인출，기비례고우량성종류환자（ P＝0．028）。환측면신경이후자격시신경전도적파폭여건측상비명현강저혹무반응파（P＜0．05），잠복시교건측연장（P＜0．05）。면신경전도적ROC곡선하면적위0．884。결론：면신경수침시，유발면신경최대동작전위적자격전류강도증고，이후자격시면신경전도적파폭교건측강저，악성종류환자무반응파인출자적비례증고。무면탄증상적시선종류환자，술전면신경전도검사유조우예측면신경수침상태。
Objective:To investigate the possibility of predicting facial nerve involvement in the pa-tients with parotid tumors using facial electroneurography (ENoG).Methods:In the study, 53 patients with primary parotid tumors were included in the study , 28 were benign tumors and 25 were malignant . There was no significant difference of tumor locations and sizes between the two groups . House-Brackmann facial nerve function evaluation was gradeⅠin all the patients who received examination of fa-cial electroneurography , including stimulation strength , amplitude , and latent time bilaterally .The facial electroneurography results in the affected side were compared with the results of contralateral normal side , intraoperative appearance and postoperative histopathological diagnosis .The facial electroneurography results were analyzed by Wilcoxon signed rank test and receiver operator characteristic ( ROC) curve. Results:During the facial electroneurography examination , the mean stimulation strength in the patients with benign parotid tumor was 20.0 mA.There was significant decrease in the amplitude at the affected side compared with the normal side upon posterior auricular stimulation ( P<0 .05 ) .But there was no significant difference in the latent time between the bilateral sides (P>0.05).However, in the patients with malignant parotid tumor , the mean stimulation strength was higher at 24.5 mA.There was signifi-cant decrease in the amplitude or even no response at the affected side compared to the normal side upon posterior auricular stimulation ( P<0 .05 ) .No response was detected in the multiple branches of facial nerve of affected sides in 36 .0%patients upon posterior auricular stimulation .The amplitude of branchesⅢand Ⅳwas significantly lower at the affected side than that at the normal side upon anterior auricular stimulation (P<0.05).The area under the ROC curve for ENoG was 0.884.Conclusion: When the facial nerve was involved by the parotid tumors , the stimulation strength in the electroneurography was larger .There was significant difference in the amplitude and the latent time of the facial nerve between the affected side and the normal side upon the posterior auricular stimulation .The rate of absence of reac-tion wave was higher in the patients with malignant tumors .It was feasible to predict the facial nerve in-volvement by ENoG for the parotid gland tumor patients without clinical appearances of facial paralysis .