半规管阻塞术与内淋巴囊减压术治疗中晚期梅尼埃病的远期疗效

目的 比较半规管阻塞术(semicircular canal occlusion,SCO)和内淋巴囊减压术(endolymphatic sac de-compression,ESD)对难治性梅尼埃病(Meniere's disease,MD)的远期疗效.方法 总结129例MD患者的临床资料,其中ESD组76例,SCO组...     

不同方式半规管阻塞术治疗顽固性梅尼埃病疗效分析

目的通过不同方式半规管阻塞术治疗顽固性梅尼埃病的临床观察及疗效分析,对比分析不同阻塞方法对眩晕的控制及听力保留率,为梅尼埃病的个体化最佳治疗方案的选择提供依据。方法回顾性分析2010年12月至2016年1月我院328例行半规管阻塞术的梅尼埃病患者的临床资料。参照梅尼埃病的诊断依据和疗效评估(2006年,贵阳)标准,所有患者均临床诊断为单侧梅尼埃病,行规范化药物保守治疗至少1年以上,但眩晕仍反复发作。其中三个半规管阻塞术302例,两个半规管阻塞术21例,包括水平半规管联合后半规管阻塞15例,水平半规管联合上半规管阻塞6例;一个半规管阻塞术5例,均为水平半规管阻塞。采用纯音测听、前庭双温试验和颈源性前庭诱发肌源性电位(cervical vestibular evokedmyogenic potential,c VEMP)进行听力学和前庭功能评估,通过内耳MRI膜迷路水成像观察阻塞术后膜迷路的形态学改变。结果三个半规管阻塞术对眩晕控制的总有效率为98.0%(296/302),A级81.8%(247/302),B级16.2%(49/302),听力保留率70.2%(212/302);两个半规管阻塞术对眩晕控制的总有效率为85.7%(18/21),A级61.9%(13/21),B级23.8%(5/21),听力保留率76.2%(16/21);一个半规管阻塞对眩晕控制的总有效率为60.0%(3/5),A级40.0%(2/5),B级20.0%(1/5),听力保留率80.0%(4/5)。三个半规管阻塞术眩晕控制有效率高于两个半规管阻塞或一个半规管阻塞术(P<0.05)。听力保留率三组之间无明显差异(P>0.05)。结论半规管阻塞术是治疗顽固性梅尼埃病的有效方法。三个半规管阻塞术眩晕控制有效率最高。     

半规管阻塞术治疗顽固性梅尼埃病的短期疗效分析

目的 观察半规管阻塞术治疗顽固性梅尼埃病的短期疗效,评价其有效性和安全性.方法 回顾性分析17例行半规管阻塞手术的梅尼埃病患者资料,均为确诊单侧梅尼埃病,行规范化药物保守治疗至少1年以上,眩晕仍反复发作者.全麻下经乳突进路行三个半规管阻塞术,术后随访6～13个月,平均10个月.术前及术后3个月采用纯音测听、冷热试验和前庭诱发的肌源性电位检查( vestibular evoked myogenic potential,VEMP)进行听力学和前庭功能评价.结果 17例梅尼埃病患者,术前按听力进行分期,Ⅱ期(平均听阈25～40 dBHL)2例,Ⅲ期(41～70 dBHL)15例.术后随访期内均无眩晕发作,眩晕控制率为100％ (17/17).同期行内淋巴囊减压术的25例梅尼埃病患者,眩晕控制率为72.0％( 18/25),半规管阻塞术的眩晕控制率高于内淋巴囊减压术(x2=3.87,P＜0.05).术后3个月12例患者纯音平均听阈与术前相比无明显变化,5例听阈提高,但均小于20 dBHL,听力下降率29.4％ (5/17).术后所有患者均出现短时间眩晕及平衡障碍,眩晕均在术后3d内消失,10例患者术后1～2周内恢复平衡功能,7例患者术后2个月内平衡障碍完全消失,平衡恢复时间平均12.6d.术后3个月复查,全部病例冷热试验均提示半规管功能丧失,VEMP检查示球囊功能无变化.所有患者均无面神经麻痹、脑脊液漏等并发症发生.结论 半规管阻塞术治疗顽固性梅尼埃病短期疗效确切,听力保留率高,不影响耳石器功能,无严重并发症,有望成为治疗存在中度以上听力损失的顽固性梅尼埃病患者安全有效的手术方法.     

内淋巴囊引流术治疗梅尼埃病

报告以内淋巴囊引流术治疗２４例梅尼埃病的结果，其中１４例随访２－３年，眩晕控制１０例，好转３例，无效１例。详细介绍了内淋巴囊引流术的手术方法，并对手术治疗的机理，适应证选择，以及并发症的以预防进行讨论。     

外科综合治疗顽固性梅尼埃病的临床观察

目的通过外科流程治疗顽固性梅尼埃病的远期临床观察,评价梅尼埃病外科流程治疗对眩晕发作控制的有效性。方法 20例顽固性、活动性梅尼埃病患者根据眩晕发作的情况依次采取低压脉冲治疗、内淋巴囊减压术及三个半规管阻塞术治疗。运用症状卡进行眩晕发作和活动状况的评测。结果 20例顽固性、活动性梅尼埃病患者平均104个月观察期内采用单纯低压脉冲治疗有效控制眩晕为17例,比例为85%;低压脉冲治疗+内淋巴囊减压术有效控制眩晕为2例,比例为10%;低压脉冲治疗+内淋巴囊减压术+三个半规管阻塞术有效控制眩晕为1例,比例为5%。结论对于顽固性梅尼埃病眩晕发作的控制需要外科流程化、综合性的治疗和远期观察。     

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。     

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。     

梅尼埃病患者内淋巴囊减压术后的生活质量研究

目的应用所设计的梅尼埃病治疗效果问卷(Meneiere’s disease oucomes questionnaire,MDOQ),对内淋巴囊减压术后梅尼埃病患者的生活质量(quality of life,QOL)进行评估研究。方法病例来自1982年1月至1998年1月药物治疗失败并进行了内淋巴囊减压术的68例梅尼埃病患者。MDOQ由三方面组成:身体的、情感的和社交的健康与愉快,有19项配对的问题(术前和术后),比较术前与术后QOL得分。结果术后QOL得分总的变化为27.8分(32~86)(P<0.001),QOL得分与MDOQ得分有很密切关系(P<0.05)。内淋巴囊减压术后QOL相应改善的MD患者占83.8%,无变化的患者占5.9%,变差的患者占10.3%。结论MDOQ是一新的对梅尼埃病患者QOL很好的评估方法,与治疗后梅尼埃病患者QOL的变化相一致。     

内淋巴囊减压与切开术疗效对比观察

目的 :观察比较内淋巴囊减压与切开术的疗效。方法 :在全麻下按常规手术方法分别行内淋巴囊减压术 2 3例 ,内淋巴囊切开术 2 2例。结果 :术后随访 4 1例 ,随访时间均在 2年以上 ,其中内淋巴囊减压术 2 1例 ,内淋巴囊切开术 2 0例。 2 1例内淋巴囊减压术患者中 ,A级 1 3例 ,B级 4例 ,C级 3例 ,D级 1例 ,完全控制率为6 1 .9% ;2 0例内淋巴囊切开术患者中 ,A级 1 2例 ,B级 5例 ,C级 2例 ,D级 1例 ,完全控制率为 6 0 .0 %。结论 :内淋巴囊减压与切开术在疗效上无显著差异 ,但内淋巴囊减压术较切开术具有操作简单、安全可靠、并发症少等优点 ,因此在术式选择上我们更偏向于内淋巴囊减压术     

Demonstration of Autoantibodies to the Endolymphatic Sac in Meniere's Disease

Recent evidence suggests that immune mechanisms may underlie some cases of Meniere's disease. This study was conducted to determine whether an autoimmune mechanism is involved. Sera from 30 patients with Meniere's disease were reacted with human endolymphatic sacs and examined by indirect immunohistochemistry and fluorescence microscopy. Three of the samples (10%) showed positive staining, indicating immunoglobulin G (IgG) binding against the sac. No positive staining occurred when sera from healthy individuals or phosphate-buffered saline was used as a control. Clinical data showed an association between immunoreactivity and extent of disease (worse hearing over a shorter disease course and bilateral involvement). This study suggests that, in some cases of Meniere's disease, autoantibodies directed against human endolymphatic sac are present in the sera, supporting the theory that a specific autoimmune reaction takes place in a minority of patients with Meniere's disease.     

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。     

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.     

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。     

Long-term results of endolymphatic sac drainage with local steroids for intractable Meniere's disease

Objectives

Meniere's disease is a common inner ear disease characterized by vertigo, hearing loss and tinnitus. Since Meniere's disease is thought to be triggered by an immune insult to inner ear hydrops, we examined endolymphatic sac drainage with intra-endolymphatic sac application of large doses of steroids for intractable Meniere's patients and observed long-term results from 2 years to over a decade until 13 years.

Methods

Between 1998 and 2009, we enrolled and assigned 286 intractable Meniere's patients to two groups: group-I (G-I) included patients who underwent endolymphatic sac drainage with steroid instillation and group-II (G-II) included those who declined endolymphatic sac drainage. Definitive spells and hearing improvement in these two groups were determined for 2–13 years after treatment.

Results

According to the established criteria, vertigo was completely controlled in 88% of patients in G-I in the 2nd year, in 73% in the 12th year and in 70% in the 13th year. These results in G-I were significantly better than those in G-II for 13 years after treatment. Hearing was improved in 49% of patients in G-I in the 2nd year, in 27% in the 12th year and in 25% in the 13th year. These results in G-I were significantly better than those in G-II for 12 years after treatment, but this was not significant in the 13th year.

Conclusions

Endolymphatic sac drainage with intra-endolymphatic sac application of large doses of steroids could improve long-term follow-up results of hearing as well as vertigo control. This means that the drainage with local steroids could also improve patients’ long-term quality in the prime of life.     

Brandt-Daroff康复练习对半规管良性阵发性位置性眩晕患者的疗效

目的探讨Brandt-Daroff康复练习对半规管良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者的疗效。方法选取2016年9月~2018年3月就诊于我院的60例半规管BPPV患者,根据随机数字表法将其分为观察组和对照组各30例,对照组采取手法复位进行治疗,观察组在其基础上行Brandt-Daroff康复练习,连续治疗1个月并随访半年。治疗前后采用眩晕障碍评分量表(dizziness handicap inventory,DHI),不良反应发生率、半年复发率,比较两组临床疗效。结果与对照组比较,观察组临床总有效率(93.33%)显著升高,差异有统计学意义(P<0.05);治疗后,两组DHI评分显著降低,且观察组降低幅度显著大于对照组,差异有统计学意义(P<0.05);两组在不良发生率的比较中差异无统计学意义(P>0.05);与对照组(20.00%)比较,观察组半年复发率(6.67%)显著降低,差异有统计学意义(P<0.05)。结论Brandt-Daroff康复练习不仅可有效提高半规管BPPV患者临床疗效,减轻其功能障碍,而且复发率低,安全性高,值得临床参考。