半规管阻塞加内淋巴囊减压治疗顽固性梅尼埃病

摘要

目的：探讨三个半规管阻塞加内淋巴囊减压治疗顽固性梅尼埃病的疗效，并总结手术要点。方法中晚期单侧梅尼埃病患者14例，术前0．25、0．5、1、2 kHz 骨导听阈35～65 dB HL；14例均在全麻下完成内淋巴囊减压术，同时磨开三个半规管骨质成骨性小窗，以软组织填塞半规管管腔；术后随访3～18月，评估患者眩晕控制情况以及听力、耳鸣的变化。结果14例均顺利完成手术，术后均无面瘫及脑脊液漏，除1例失访外，余13例均未再发生眩晕；8例听力较术前无变化，5例语言频率平均骨导听力较术前下降10～15 dB；10例耳鸣无变化，1例耳鸣变为偶发，2例耳鸣加重。结论半规管阻塞加内淋巴囊减压术对中、晚期梅尼埃患者中短期眩晕控制良好，但内淋巴囊减压并不能缓解半规管阻塞引起的听力损失风险。%Objective To study the effects of endolymphatic sac decompression and on semicircular canal plugging in treating intractable Meniere's disease.Methods A total of 14 cases of intractable Meniere's disease were included in this study.The age was from 33~67 years old and the history was from 1 to 40 years.The hearing level of bone was from 35 to 65 dB for the speech frequencies.All cases received the treatments according to the pre-op-erative design.The endolymphatic sac was decompressed and the three semicircular canal bones were drilled to cre-ate a fenestra followed by soft tissue plugging into the canal.The vertigo,hearing level and tinnitus were included in the following up.Results All cases had no facial palsy,no cerebrospinal leak,and no vertical after surgery.In the period of 3 to 18 months following up,the attack of Meniere's disease was completely controlled for 13 cases excep-tion of one lost case.For five cases,the hearing level descended 10 to 15 dB compared to pre-operation.Conclusion Although the endolymphatic sac decompression can relieve endolymphatic pressure,this may not adequately pro-tect the hearing caused by the semicircular canal plugging.The surgical technique is reliable and safe;however fur-ther clinical data should be gathered.