CAJ | 학술논문

目的：探讨面神经监测仪在完壁式鼓室成形术中的应用价值。方法在面神经监测下完成完壁式鼓室成形术21例，术中在解剖定位的基础上用面神经监测仪确认面神经的走行，尤其经面隐窝进路开放后鼓室过程中实时监测预防损伤面神经，记录开放前后刺激阈值。结果术中发现面神经前移1例。完成完壁式手术的21例患者中，面隐窝进路开放后鼓室前面神经乳突段刺激阈值为0.38～0.90mA，平均(0.66±0.16)mA，开放后面神经乳突段刺激阈值为0.16～0.43mA,平均（0.32±0.09）mA。经配对t检验，差异有统计学意义（p＜0.05）。术中发现面神经骨管缺损4例。术后无一例患者出现即发性或迟发性面瘫。术后半年全部干耳。结论面神经监测仪能在完壁式鼓室成形术中有效识别面神经，有助于扩大面隐窝的开放范围、彻底清除病灶而不增加面神经损伤的机会。
목적：탐토면신경감측의재완벽식고실성형술중적응용개치。방법재면신경감측하완성완벽식고실성형술21례，술중재해부정위적기출상용면신경감측의학인면신경적주행，우기경면은와진로개방후고실과정중실시감측예방손상면신경，기록개방전후자격역치。결과술중발현면신경전이1례。완성완벽식수술적21례환자중，면은와진로개방후고실전면신경유돌단자격역치위0.38～0.90mA，평균(0.66±0.16)mA，개방후면신경유돌단자격역치위0.16～0.43mA,평균（0.32±0.09）mA。경배대t검험，차이유통계학의의（p＜0.05）。술중발현면신경골관결손4례。술후무일례환자출현즉발성혹지발성면탄。술후반년전부간이。결론면신경감측의능재완벽식고실성형술중유효식별면신경，유조우확대면은와적개방범위、철저청제병조이불증가면신경손상적궤회。
Objective To study the value of facial nerve monitoring during canal wall up mastoidectomy with tympano?plasty. Methods Canal wall up mastoidectomy was performed in 21 cases of chronic suppurative otitis media through facial re?cess approach with intraoperative facial nerve monitoring. Stimulus thresholds before and after opening the facial recess were recorded.Results Abnormally anterior course of facial canal was seen in 1 case. In the 21 cases in which canal wall up sur?gery was completed, the stimulus thresholds at the mastoid segment ranged from 0. 38~0. 90 mA(mean=0.66±0.16 mA)be?fore opening the facial recess and 0.16~0.43 mA(mean=0.32±0.09 mA)after facial recess was opened(p<0.05). Facial ca?nal defects were found in 4 cases under microscopes. There was no immediate or delayed facial paralysis after surgery. All patients obtained dry ear at six months follow up. Conclusion Intraoperative facial nerve monitoring can help surgeons identify and locate the facial nerve, facilitating broad facial recess access in canal wall up surgery while effectively protecting the facial nerve.