双镜联合在治疗面肌痉挛微血管减压术中的临床应用

摘要

Objective To evaluate the effectiveness and safety of the endoscope combined with microscope for the microvascular decompression in hemifacial spasm.Methods A total of 26 patients underwent endoscope combined with microscopic facial nerve microvascular decompression through retrolabyrinthine approach from January 2013 to December 2016 were retrospectively reviewed in Ear Institute,Shanghai Jiaotong University School of Medicine.Among them,9 were male and 17 were female,with a mean age of (51.9i 11.4) years;15 cases of left side and 11 of right side patients were followed up for 1-3 years.The pre-and post-operative Cohen Classification was used for hemifacial spasm,House-Brackmann Grade for facial nerve function,hearing level and complication rates were reviewed.SPSS 19.0 software was used to analyze the data.Results All 26 patients were operated successfully.No recurrence was seen during 1-3 year follow-up.Post-operative Cohen Grade were as follows:25 cases with Cohen Grade I and 1 case with Cohen Grade Ⅱ.The difference in Cohen grade between pre-and post-operative was statistically significant (Z=-4.87,P＜0.01).Post-operative facial nerve function was satisfactory in all patients (House-Brackmann Grade Ⅰ-Ⅱ in all patients).No hearing loss was observed.No facial paralysis and other lower cranial nerve dysfunction were observed.No postoperative complications such as cerebrospinal fluid leakage occurred.Conclusions Using an angled endoscope combined with microscope in microvascular decompression in hemifacial spasmis is safe and effective.%目的 探讨内镜联合显微镜治疗面肌痉挛的有效性和安全性.方法 回顾性分析2013年1月至2016年12月上海交通大学医学院耳科学研究所收治的26例面肌痉挛患者的临床资料,其中男9例,女17例;平均年龄(51.9±11.4)岁;左侧15例,右侧11例;Cohen面肌痉挛分级为Ⅱ级2例,Ⅲ级23例,Ⅳ级1例.26例患者均采用迷路后进路内镜联合显微镜下面神经微血管减压术治疗.术后随访1～3年,评估Cohen面肌痉挛分级、House-Brackmann面神经功能分级、纯音听阈改变情况以及并发症发生情况.采用SPSS 19.0软件对数据进行统计学分析.结果 26例患者均成功手术,术后Cohen面肌痉挛分级为:Ⅰ级25例,Ⅱ级1例,较术前差异有统计学意义(Z=-4.87,P＜0.01).术后随访1～3年未见复发.术后面神经功能良好(HB分级Ⅰ～～Ⅱ级),听力未见明显下降,术后无后组颅神经等非责任神经并发症.无一例患者出现脑脊液漏等颅脑并发症.结论 内镜联合显微镜微血管减压术治疗面肌痉挛安全有效.