梅尼埃病两种内淋巴囊手术方式的远期疗效观察

目的：评估与比较内淋巴囊乳突腔分流术（EMS）和内淋巴囊减压术（ESD）治疗梅尼埃病（MD）的远期疗效。方法：1994—06—2007—07采用内淋巴囊手术治疗原诊断为MD的患者59例,其中EMS34例,ESD25例,选择诊断符合MD诊断依据和疗效评估标准,术后2年以上、随访资料完整的23例24耳（分流术12例13耳,减压术11例11耳）进行回顾性总结。结果：EMS组12例13耳,随访3～14年,眩晕A级完全控制者9耳,B级基本控制4耳;ESD组11例11耳,随访2-14年,术后眩晕A级8耳,B级2耳,C级1耳。EMS组听力B级1耳（7．7％）,C级6耳,D级6耳;ESD组听力B级2耳（18．2％）,C级4耳,D级5耳。2组眩晕控制和听力改善差异无统计学意义。结论：EMS和ESD都是治疗MD的有效方法,对眩晕症状的控制效果满意,临床分期中晚期患者仍有疗效。     

夹型硅胶在内淋巴囊引流术中的应用

目的探讨应用夹型硅胶内淋巴囊引流术治疗梅尼埃病的方法和疗效.方法 对12例梅尼埃病患者于显微镜下行内淋巴囊引流术,置入夹型硅胶,术后随访1年6个月至4年8个月.结果按疗效评定标准,A级3例,B级5例,C级3例,D级1例.有效率91.67%.结论夹型硅胶内淋巴囊引流术治疗梅尼埃病能保证引流通畅,保留听力.     

显微镜下内淋巴囊引流术治疗梅尼埃病(附12例报告)

目的 探讨内淋巴囊引流术治疗梅尼埃病的手术方法和疗效。方法 对12例梅尼埃病的病人行显微镜下内淋巴囊引流术,并进行了术后随访。结果 随访结果表明,按疗效评定标准,A级3例;B级5例;C级3例;D级1例。有效率91.67％。结论 内淋巴囊引流术是治疗梅尼埃病的有效的保留听力的手术方法,值得临床推广应用。     

内淋巴囊引流术治疗梅尼埃病的远期疗效

目的评估内淋巴囊引流术治疗梅尼埃病的远期疗效。方法选择1987年3月至2004年9月住院的接受内淋巴囊引流术治疗的梅尼埃病患者共26例，对随访2年以上、资料完整的18例进行了回顾性总结。其诊断和疗效评价均依据1996年中华医学会耳鼻咽喉科学分会和中华耳鼻咽喉科杂志编辑委员会制订的梅尼埃病诊断依据和疗效分级标准。结果18例患者随访2～13年，其中2～5年2例，≥5年16例；平均9．28年。18例患者术后眩晕A级（完全控制）9例（50％），B级（大部分控制）8例（44．4％），D级（加重）1例（5．6％）；耳鸣消失2例（11．1％），减轻9例（50％），无效7例（38．9％）；耳闷胀感消失10例（55．6％），无效8例（44．4％）；听力提高（A＋B级）6例（33．3％），无明显变化（C级）4例（22．2％），下降（D级）8例（44．5％）。手术后均无面神经麻痹、脑脊液瘘、出血、切口感染等并发症。结论内淋巴囊引流手术是治疗梅尼埃病安全有效的方法，大部分病例术后听力得以保存。     

梅尼埃病手术治疗的探讨

目的：探讨不同手术治疗梅尼埃病的临床疗效。方法：对21例梅尼埃病患者行内淋巴囊减压术．9例行乙状窦后前庭神经切断术，并进行随访观察。结果：术后经3～6年随访，内淋巴囊减压组眩晕完全控制11例，基本控制4例，部分控制4例，未控制2例。前庭神经切断组眩晕均得到完全控制。结论：内淋巴囊减压术仍然是手术治疗梅尼埃病的首选方法，但对内淋巴囊手术治疗无效或严重眩晕失去工作能力者．应考虑采用前庭神经切断术。     

单纯内淋巴囊减压术治疗梅尼埃病的远期疗效

报告以单纯内淋巴囊减压术治疗梅尼埃病５８例中，经随访５－６．５年的３０例眩晕完全消失者２１例。表明单纯内淋巴囊闰坟术与内淋巴囊切开术或分流术的疗效近似而且引起严重并发症的机会较少。并对本手术的作用机理，操作要领及并发症的预防等进行讨论。     

联合应用内淋巴囊减压和局部激素治疗难治性梅尼埃病的短期与长期疗效分析

目的 探讨内淋巴囊减压联合经面隐窝鼓室内激素注射以及内淋巴囊表面覆盖激素明胶海绵治疗难治性梅尼埃病的短期与长期临床效果。 方法 回顾分析针对难治性梅尼埃病进行手术治疗的23例患者资料。手术方式在传统内淋巴囊减压的基础上,开放面隐窝,并在圆窗周围放置明胶海绵,鼓室内注射激素,同时在内淋巴囊表面放置明胶海绵并在乳突内注射激素。比较患者治疗前6个月与术后6~12个月(短期疗效),以及术后18~24个月(长期疗效)的眩晕发作次数以及平均听阈水平(500、1 000、2 000 Hz)。 结果 23例患者完成短期疗效评价,术后眩晕发作次数由(5.7±5.9)次(术前6个月)降至(0.4±1.0)次(术后6~12个月),眩晕控制率为87.0%。术后听力维持率为95.7%。13例患者完成长期疗效评价,术后眩晕发作次数由(4.2±2.6)次(术前6个月)降至(0.1±0.3)次(术后18~24个月),眩晕控制率为92.3%,术后听力维持率为100%。 结论 内淋巴囊减压联合局部激素治疗对于保守治疗无效的难治性梅尼埃病具有良好的眩晕控制率和听力维持率,值得推广。     

内淋巴囊减压术治疗Lermoyez综合征患者效果评估

目的研究内淋巴囊减压术治疗Lermoyez综合征的临床效果。方法病例材料来源于我科2007年至2013年收治的Lermoyez综合征病例共6例,均为经保守治疗后仍反复发作眩晕者,术前完善检查,行内淋巴囊减压术,术后进行随访,评估眩晕、听力、耳鸣、耳闷变化。结果术后66.7%(4/6)患者眩晕完全控制,33.3%(2/6)患者眩晕基本控制,57.1%(4/7)的患耳听力好转,33.3%(2/6)的患耳耳鸣减轻,80%(4/5)的患耳耳闷胀感减轻。结论内淋巴囊减压术能有效控制Lermoyez综合症患者的眩晕发作,是治疗该病的一种可行方法。     

影响内淋巴囊减压术后生活质量的相关因素分析

目的研究内淋巴囊减压术治疗梅尼埃病的临床效果;通过患者术后生活质量评分分析手术适应症及影响手术效果的相关因素。方法病例材料来源于北京大学人民医院耳鼻咽喉科1996年至2011年收治的梅尼埃病病例共71例,选择反复发作眩晕且有实用听力者进行内淋巴囊减压术,术前完善检查并根据听力分期、听力曲线、病程、随访期限等进行分组,术后进行随访,生活质量的评测采用梅尼埃病内淋巴囊减压术生活质量调查问卷MDOQ。结果内淋巴囊减压术后生活质量相应改善的梅尼埃患者为87.69%,3.08%不变,9.23%变差。QOL的得分与年龄、性别、随访时间、病程等无明显统计学相关,与术前听力分期、术前听力学曲线类型有统计学意义。结论内淋巴囊减压术能有效改善梅尼埃病患者的术后生活质量。术前不同分期与内淋巴囊减压术后疗效有明显统计学差异,分期为2、3期的患者疗效要好于4期患者,听力曲线为上升型的效果优于其他类型。     

梅尼埃病的手术疗效分析

目的比较前庭神经切断及内淋巴囊手术治疗梅尼埃病效果。方法将所有梅尼埃病患者根据听力及生活质量情况进行分期;根据分期情况予以非手术治疗以及内淋巴囊减压或引流术、前庭神经切断术。分析手术治疗梅尼埃病患者病史特点、手术情况;对于手术满24个月以上的梅尼埃病患者进行术前术后的眩晕、听力及生活质量等疗效评价。结果手术治疗梅尼埃病共77例患者79次手术(1例双侧梅尼埃病患者接受左右各1次内淋巴囊减压术;另1例双侧梅尼埃病患者接受了左侧前庭神经切断术及1次右侧内淋巴囊减压术),其中内淋巴囊手术34次,前庭神经切断术45次。术后24个月的眩晕控制率为:内淋巴囊手术73%,前庭神经切断术100%。结论内淋巴囊减压或引流术可以减轻患者眩晕、改善患者的生活质量;前庭神法。     

Endolymphatic sac decompression as a treatment for Meniere's disease

OBJECTIVES/HYPOTHESIS: Endolymphatic sac decompression is a surgical treatment option for patients with medically intractable Meniere's disease. However, effectiveness is debated because published data show great variability. Outcome-based research studies are useful in incorporating the patient's perspective on the success of treatment. To further assess effectiveness of endolymphatic sac decompression, we performed a prospective study to examine both symptom-specific and general health outcomes. STUDY DESIGN: Prospective, observational outcome study. METHODS: Nineteen patients with endolymphatic sac decompression responded to symptom-specific questionnaires and the Medical Outcomes Short-Form 36 Health Survey (SF-36) before and after surgery. Follow-up ranged from 6 to 58 months with a mean duration of 50 months. RESULTS: Overall measures of physical health were significantly improved following endolymphatic sac decompression (P = .04), whereas overall measures of mental health were unchanged (P = .74). Role Physical and Social Functioning scores were significantly improved following endolymphatic sac decompression (P = .04 and P = .03, respectively). Study patients scored significantly lower (P < .05) than SF-36 normative data in 6 of 10 categories before endolymphatic sac decompression but patient scores were not significantly different from normal scores in all but one category (General Health) following endolymphatic sac decompression. The mean number of vertigo episodes was significantly reduced from an average of 8.3 times per month to an average of 2.6 times per month following endolymphatic sac decompression (P = .006). Ninety-five percent of patients (18 of 19 patients) reported improvement in symptoms (frequency, duration, or intensity) of vertigo and 37% (7 of 19 patients) reported complete resolution of vertigo. CONCLUSION: Endolymphatic sac decompression significantly improved perception of physical health, as well as symptom-specific outcomes, in patients with medically intractable Meniere's disease.     

半规管阻塞加内淋巴囊减压治疗顽固性梅尼埃病

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。     

Surgical treatment of endolymphatic sac tumor

The objective of this study was to understand the clinical characteristics of endolymphatic sac tumor and to optimize its diagnosis and treatment. We carried out a retrospective review of 11 patients diagnosed as having endolymphatic sac tumor based on operative findings and pathological features, and their clinical manifestations, differential diagnosis, and surgical approaches are discussed in detail. The lesions of 10 cases were completely surgically resected, two cases via the mastoid approach, 8 cases via the oto-cervical or cranio-oto-cervical combined approach. In one case the tumor was partially removed and the patient received adjuvant radiotherapy. In operation, four cases had facial-hypoglossal neural anastomosis, two cases had great auricular nerve graft, and in four cases the facial nerve integrity remained. Survival follow-up data range from 14 months to 10 years. We conclude that endolymphatic sac tumor is very rare and easily misdiagnosed. Reasonable surgical treatment can provide a good prognosis.