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。     

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。     

枕下进路前庭神经切断术:结果和并发症

枕下进路前庭神经切断术是控制眩晕的有效方法，下面报告40例手术结果及并发症。4（例中梅尼埃病23例，耳蜗前庭神经压迫综合征9例、中耳炎并发的迷路炎2例，外伤及钦肯切除术后各显例、原因不明者4例。均为单侧前庭功能紊乱，4例曾行内淋巴囊手术，1村曾行迷路后前庭神经切断术。手术采用仰卧位头偏向健侧、头颈躯干抬高45“体位全麻下手术。切除前庭神经时连续监测ABR、ECOG，以免损伤耳蜗神经。术中行内听道开放者了例，未开放者33例。切斯前庭神经者37例，切断全部前庭耳蜗神经者3例。随访12个月，40例中36例（gD畅）眩晕完全消失，…     

迷路后神经切断术失败后的颅中窝前庭神经切断术

对迷路后前庭神经切断(RLVN)无效的或不能站立行走的严重眩晕患者可采用颅中窝前庭神经切断术(MFVN)。作者于1985～1990年间对RLVN失败的11例患者,进行了颅中窝进路的前庭神经切断术,女性8例,男性3例,平均年龄47.4岁,梅尼埃病引起的眩晕8例,慢性中耳炎伴有内淋巴积水症状2例,镫骨手术失败1例。接受MFVN以前的病     

经后颅窝前庭神经切断术

前庭神经切断术治疗顽固性眩晕并能保存听力,该方法首先在1904年由Parry提出,1930年McKenZie首例作了前庭神经切断术。作者从1987年3月到1990年2月对12例梅尼埃病和2例突聋病人进行经后颅窝前庭神经切断术,所有病人术前都采取了保守治疗,其中6例病人曾做过内淋巴囊手术,均未能控制眩晕。在14例病人中有7例采取经迷路后进路,5例经乙状窦进路,2例死耳患者采取经膜迷路进路。按照AA00划分法,手术后,所有病人的眩晕程度都在A～C级之间:听力1例提高,1例下降,其余无明显变化;12例仍有耳闷胀感;1例耳鸣减轻,2例加重;出现脑脊     

梅尼埃病手术方法的选择

为总结选择不同的手术方法治疗梅尼埃病的经验，分析１１９例（１１９耳）采用手术方法治疗的梅尼埃病患者。诊断和疗效评定按１９９６年上海全国会议制定的梅尼埃病诊断依据和疗效分级，在病的分期和劳动能力方面，参照ＡＡＯ－ＨＮＳ１９９５年的梅尼埃病的诊断和疗效评价标准分期：第二期４８例均行内淋巴囊分流术；第三期４４例，行Ｓｃａｒｐａ神经节切除术３２例，迷路入路前庭耳蜗神经切断术１２例；第四期２７例，行Ｓｃａｒｐａ神经节切除术４例，内淋巴囊分流术７例，前庭耳蜗神经切断术１６例。结果：内淋巴囊分流术对可逆性病变眩晕好转率为７９．２％，听力维持在正常水平者达３５．４％；Ｓｃａｒｐａ神经节切除术应用于尚存实用听力和可助听力的患者；迷路入路前庭耳蜗神经切断术对晚期梅尼埃病的耳鸣有较佳疗效。认为：根据梅尼埃病患者临床表现判断病变的可逆性和程度，实施不同的手术方法是十分重要的。     

非梅尼埃病眩晕的手术治疗

保守治疗失败的梅尼埃病患者手术治疗已普遍接受。非梅尼埃病致残性眩晕亦可手术治疗。对14例非梅尼埃病致残性眩晕的患者行迷路切除术或前庭神经切断术。其中慢性前庭神经炎4例,均行前庭神经切断术,1例治愈,3例好转。颞骨骨折2例行迷路切除术,痊愈。迟发性眩晕8例,2例行迷路切除术,6例行前庭神经切断术,均获痊愈。既往对非梅尼埃病眩晕是否采用手术治疗意见并不一致,较为普遍的看法是非梅尼埃病眩晕手术治疗效果较典型梅尼埃病差,该文采     

内淋巴囊-静脉减压术治疗难治性梅尼埃病

梅尼埃病的治疗仍有争论,大多药物治疗有效,仅少数药物无效者方行手术治疗。手术方法很多,目前多采用乙状窦后径路前庭神经切断术、化学性迷路破坏术、内淋巴囊减压和分流术。前庭神经切断术可保存听力,眩晕消失率高达８５％～９９％,但可因后颅窝开颅术引起颅内感染...     

迷路切除术与前庭神经切断术对控制眩晕的比较

对1979～1994年间经保守治疗无效的126例眩晕病人进行手术治疗作回顾性分析。126例中采用迷路．切除术sl例，前庭神经切断术45例。病因为梅尼埃病89例，迷路炎15例，迟延性内淋巴积水8例，前庭神经炎7例，迷路切除术后失败5例，其余2例因需经迷路行岩尖部囊肿造疾术而牺牲的正常迷路。比较两种手术方法对解除眩晕的疗效：迷路切除术为98．8％，前庭神经切断术为978％，但两种术式在其它方面存在显著差异。①经顿中窝前庭神经切断术常用于术前听力较好的病例，本组选择性前庭神经切断术中82％术后保存了听力，其中5例术后听力提高。一般认为…     

经前庭达内耳道手术

著者提出,给单侧美尼尔氏病作手术治疗时应考虑两点:(1)对保守治疗有效的患者其手术目的是消除前庭功能、减少眩晕发作及保存听力。手术方法有内淋巴囊手术、超声波治疗和经颅中窝前庭神经切断术。(2)丧失应用听力及保守治疗失败者可采用经外耳道迷路切除术和经迷路前庭神经切断术,二者都能起到消除眩晕的作用。     

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。     

Triple semicircular canal occlusion for the treatment of Ménière's disease

CONCLUSION: Triple semicircular canal occlusion (TSCO) controls vertigo, is easy to perform, and could be used as an alternative procedure for the treatment of Meniere's disease in selected patients who complain mainly of intractable vertigo. OBJECTIVE: To seek an effective alternative surgical procedure for treating Ménière's disease in selected patients with intolerant rotational vertigo. PATIENTS AND METHODS: Three patients with Ménière's disease who underwent unsuccessful endolymphatic sac decompression or mastoid shunt, then underwent TSCO. Vertigo control and vestibular and auditory function were measured. RESULTS: The early vestibular symptoms caused by surgery resolved quickly and no hearing deterioration occurred after surgery. At the end of the follow-up period, based on the AAO-HNS criteria, two cases had complete control of vertigo (class A) and the other had substantial control of vertigo attacks (class B). Hearing was similar to the preoperative level at the end of the follow-up period.     

Endolymphatic sac surgery: methods of study and results

Surgery of the endolymphatic sac (ELS) in classical Meniere's disease has fallen under attack and has been abandoned by some surgeons. We studied our results for vertigo and hearing in 83 patients undergoing surgery of the ELS for intractable classical Meniere's disease. Half of the patients were completely free of definitive attacks at 2 years; another quarter experienced substantial control. Three fourths noted an improvement in their level of disability. Results for vertigo were sustained at longer follow-up intervals. Nineteen percent had revision surgery (usually retrolabyrinthine vestibular neurectomy) for intractable vertigo within 2 years of the sac operation. The 1985 reporting method of the American Academy of Otolaryngology--Head and Neck Surgery was found superior to previous methods because it specified a meaningful follow-up interval, used a graded scale accounting for partial success in treatment, and separated results for vertigo and hearing. Nevertheless, optimal use of the method in the future will require prospective reporting and a concerted effort to avoid confusion between definitive attacks of true vertigo and adjunctive vestibular symptoms. Even though the mechanism of the beneficial effect of sac surgery is unknown, we have found it useful in the control of disabling vertigo.     

Long-term results of Meniere's disease treatment

The authors present long-term results of Meniere's disease treatment: 2, 5, 10, 15, 20 and more years after drainage and exposure of the endolymphatic sac, chordoplexustomy (50 patients), conservative treatment (20 patients). Acoustic and vestibular functions in these patients are compared. Choice of Meniere's disease effective treatment depends on accurate diagnosis of the disease for which it is important to stage the disease exactly, to assess functional condition of the internal ear (cochlear secretion, lesion of the vestibular analyser, in particular). The most effective and safe treatment for Meniere's disease is now decompressing surgery on the endolymphatic sac. These not only preserve but also improve hearing at early stages of the disease.     

半规管阻塞技术的初步临床应用

目的初步探讨临床应用半规管阻塞技术治疗位置性眩晕与梅尼埃病的安全性与有效性。方法回顾性分析1994-2000年间半规管阻塞技术临床应用的资料,其中,后半规管位置性眩晕2例,水平半规管位置性眩晕1例,内淋巴囊阻塞术后5年复发的梅尼埃病1例,男1例,女3例,年龄39-58岁。梅尼埃病患者行三半规管阻塞及内淋巴乳突腔分流术,位置性眩晕患者行相应的半规管阻塞术。结果位置性眩晕患者术后随访1.5-7年,全部患者位置性眩晕得到解除,术后纯音测听、中耳功能分析、听觉脑干电反应测试、耳声发射等听觉功能检查结果显示耳蜗功能与术前完全一致,水平半规管阻塞的患者双耳冷热试验结果显示手术消除了水平半规管的功能,后半规管阻塞的患者双耳冷热试验结果显示手术后以水平半规管为代表的其它前庭末梢器官的功能得到良好的保存。内淋巴囊阻塞术后5年复发的梅尼埃病患者术后随访2年,眩晕得到完全控制。结论半规管阻塞技术可有效控制位置性眩晕与梅尼埃病患者的眩晕,半规管阻塞对患者耳蜗功能及所阻塞半规管以外的其它前庭末梢器官功能没有影响,半规管阻塞技术可望成为位置性眩晕和梅尼埃病安全、有效的治疗手段,符合现代外科学对手术微创的要求。     

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。     

Surgical treatment of Menière's disease since Thomsen

The effects of Thomsen's 1981 report of a controlled double-blind study on the surgical treatment of Meniere's disease were studied by reviewing the current literature and Thomsen's subsequent reports. The current surgical literature was found to contain reasonable support for the continued use of endolymphatic shunt procedures despite the criticism of such procedures by Thomsen. Surgical therapy for Meniere's disease continues to be divided into auditory sparing or conservative procedures and auditory ablative or destructive procedures. Conservation procedures are important because approximately 30% of patients with Meniere's disease progress to bilateral involvement. Endolymphatic sac procedures continue to be classified as conservative. Important findings in the current literature are reports of long-term follow-up of patients after sac surgery. These question the long-term control of hearing loss but support the use of the procedure due to its low morbidity and consistent control of vertigo. Other authors have described the different types of endolymphatic procedures and confirm their equal effectiveness. The results of middle fossa and retrolabyrinthine vestibular neurectomy were also reviewed, and its continued control of vertigo were affirmed. The increased number of severity of complications (compared with endolymphatic shunt procedures) were noted. Finally, a strategy for surgical treatment of Meniere's disease, beginning with the patient with uncontrollable vertigo, is presented.     

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。     

Surgical management of special cases of intractable Meniere's disease: unilateral cases with intact canals and bilateral cases

If a clinician seeks to allow patients with vertigo to return to work as soon as possible, it is very important to determine the appearance of vestibular symptoms during convalescence just after treatment, as well as the long-term results. Apprehensive patients with vertigo may undergo severe psychological torment if treatment requires long-term rest in bed before they can return to daily life. In this paper, we observed postoperative vestibular symptoms (subjective sensation and objective nystagmus) in 50 patients with intractable Meniere's disease, including cases from our previous preliminary report, during the period of convalescence just after endolymphatic sac drainage and steroid instillation surgery (EDSS). All symptoms were eliminated within 8 days after EDSS. There was no significant difference in the duration of any vestibular symptoms between bilateral (n = 8) and unilateral cases (n = 42). This result indicates that EDSS could be as safe a treatment for bilateral Meniere's disease as for unilateral disease. In unilateral cases with intact semicircular canal function (n = 17), postoperative evoked vestibular sensation, positional, and positioning (Dix-Hallpike) nystagmus disappeared significantly earlier than in those with canal paresis (n = 25). This result indicates that EDSS could keep the vestibular peripheral function of patients with unilateral Meniere's disease with intact canals quite stable after surgery. Therefore, EDSS could be recommended as an initial, less-invasive surgical treatment for intractable Meniere's disease, especially in unilateral cases with intact canals and in bilateral cases.