内淋巴囊乳突分流术治疗Meniere病长期疗效观察

采用内淋巴囊乳突分流术治疗１０例Ｍｅｎｉｅｒｅ病患者，随访３－５年，术后眩晕控制满意，其中眩晕疗效值为０值３例，１－４０者７例；多数患者（７／１０）耳鸣减轻或消失，仅１例术后听力下降。该手术安全，并发症少、术后恢复快。对药物治疗无效，患耳尚有听力的Ｍｅｎｉｅｒｅ病患者可首选内淋巴囊乳突分流术。     

淋巴囊乳突分流术治疗Ménière病长期疗效观察

采用内淋巴囊乳突分流术治疗１０例Ｍｅｎｉｅｒｅ病患者，随访３～５年，术后眩晕控制满意，其中眩晕疗效值为０者３例，１～４０者７例；多数患者（７／１０）耳鸣减轻或消失，仅１例术后听力下降。该手术安全、并发症少、术后恢复快。对药物治疗无效，患耳尚有听力的Ｍｅｎｉｅｒｅ病患者可首选内淋巴囊乳突分流术。     

内淋巴囊切开术治疗梅尼埃病的远期疗效观察

采用内淋巴囊切开乳突腔分流术治疗梅尼埃病１１例，随访３～６年，术后眩晕控制５例，好转４例，无效２例，听力提高３例，无变化７例，下降１例，多数患者耳鸣、耳闷胀感有不同程度的改善。本组病例观察乳突的气化程度与内淋巴囊的位置及大小有相关性，内淋巴囊表面的血管分布与术后疗效有相关性。     

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     

美尼尔氏病的内淋巴囊手术效果

从1976年元月至1982年7月,作者对72例美尼尔氏病患者进行了内淋巴囊手术。其中65例单侧发病,7例双侧发病。手术指征为:由于眩晕而不能工作、以及经利尿剂治疗无效者。本文介绍了三种内淋巴囊手术方法——单纯内淋巴囊切开术,囊切开带蒂颞肌瓣插入术,以及囊切开伴内淋巴-乳突分流术。对于术后仍不能控制眩晕者,根据当时听力水平决定给予前庭神经切断术或迷路破坏术。     

内淋巴囊手术:为什么我们不做?

1981年作者曾报道单纯乳突凿开水与内淋巴囊分流术治疗梅尼埃病可获相同效果，认为内淋巴囊手术实际上是起安慰作用，引起强烈反响，许多报道相继提出异议。为此该作者再次对内淋巴囊手术疗效进行讨论。手术的作用机理。内淋巴囊手术包括减压术、分流术和内淋巴囊切除术三种方式。减压术的机理难以证实，因为内淋巴囊本身嵌在硬脑膜内，囊的颅内壁已经减压，分流术试图将一根引流管插入囊腔中，会对内淋巴囊内壁产生某种程度的损伤，期望对总量不足半滴的液体进行引流，甚至设想经内淋巴管引流椭圆囊内的内淋巴液，似乎有些不合理。即使这种…     

内淋巴囊解剖及临床意义

为了解内淋巴囊的解剖变异情况，解剖甲醛固定的颞骨28侧，观察26例行内淋巴囊减压术的Meniere病患者的内淋巴囊位置、局部血管分布情况，显微镜下测量长和宽。结果28例颞骨均找到内淋巴囊，其平均长度为6．94±2．04mm，平均宽度为5．88±1．65mm。囊表面血管分布显示不清晰。26例Meniere病者24例找到内淋巴囊，平均长度为6．81±2．24mm，平均宽为5．67±1．51mm。囊表面血管分布不清晰者占29％。根据观察，内淋巴囊的位置通常位于Donaldson线上，乳突气化程度不佳时，囊位置多靠下，且较小。为内淋巴囊手术时的定位及识别提供了解剖学参考。     

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。     

先天内耳畸形的内淋巴囊手术

基于先天性内耳畸形的内淋巴囊组织病理变化与美尼尔氏病内淋巴囊水肿的表现类似,对40例(49耳)先天性进行性感音聋患儿采取了内淋巴囊手术治疗,其结果分析如下:40例中有31例为单耳手术,9例为双耳手术。内淋巴囊-蛛网膜下腔分流术(46耳),内淋巴囊-乳突分流术(2耳)及内淋巴囊减压术(1     

内淋巴囊分流术

大多数梅尼埃病的致残性眩晕都能用内科疗法得以控制,但内科治疗无效的病人,早期施行内淋巴囊乳突分流术是控制眩晕的首选办法。500例内淋巴囊手术病人的结果证明,内淋巴囊乳突分流术与内淋巴囊蛛网膜下分流术的结果是十分接近和相似的,而且前者危险性小。这种方法适用于典型的单侧梅尼埃病病人,尤其适用于无残余听力的患耳。手术通常是在全麻下进行。经耳后切口,采用单纯乳突凿开术进路。术中不需要暴露分离钻骨,后半规管不用蓝线化,面神经也不用常规轮廓化。     

Endolymphatic sac drainage and steroid-instillation surgery (EDSS) for intractable Meniere's disease

Endolymphatic sac surgery is one of the most widely accepted techniques used to treat intractable Meniere's disease. To improve this surgery, we developed the following techniques: A simple mastoidectomy was used to expose the endolymphatic sac between the sigmoid sinus and inferior margin of the posterior semicircular canal. The sac was opened and filled with a mass of prednisolone. A bundle of absorbable gelatin films was then inserted into the sac lumen to expand it, followed by gelatin sponges dipped in a high concentration of dexamethasone. Long-term results (17-32 months) in 20 patients with intractable Meniere's disease treated with endolymphatic sac drainage and steroid-insertion surgery (EDSS) showed that definitive spells were completely controlled in 15 of 20 cases (75%); all reports of vertigo decreased; hearing improved in 12 of 20 cases (60%); and annoyance due to tinnitus decreased in 15 of 20 cases (75%). Steroids directly instilled into the endolymphatic cavity may thus be more effective with the diseased inner ear organs than those applied via any other route. Draining of endolymphatic fluid at the sac into the mastoid cavity also contributed to these satisfactory EDSS results.     

Eine eigene chirurgische Methode zur Behandlung der Menièreschen Erkrankung,Saccotomie und Dekompression des hinteren Bogenganges (Film)

Summary Contribution to Portmann's approach, I like to mention our own modifications in the form of saccotomy and decompression of the posterior semi-circular canal, until perilymph leakage is noticed from the porus bone as the skin perscipitates during the warm season. Postauricular incision; mastoidectomy. The endolymphatic sac will be exposed, which is a durai duplication of the small brain at the posterior wall, lying between sigmoid sinus and inferior to the posterior semicircular canal. The lateral wall of the sac is incised and removed. In addition to this, the posterior semicircular canal is thinned with the diamond drill, until the perilymph fluid leaks out slowly. These remain uncovered. One must take care not to suck this fluid. In this way we achieve both — a direct and indirect decompression of endolymphatic system. Results of the postoperative check up 3 years in 30 cases after this method is demonstrated.     

难治性梅尼埃病手术控制眩晕的远期疗效观察

目的：观察难治性梅尼埃病手术控制眩晕的远期疗效。方法：施行内淋巴囊手术或经迷路进路前庭神经切断术治疗难治性梅尼埃病５４例,其中长期接受随访、资料完整者１２例。结果：随访８￣１３年,６例前庭神经切断术患者示再发作眩晕;６例内淋巴囊手术者,３例眩晕症状完全控制,３例基本控制。结论：肉淋巴囊手术及经迷路进行前庭神经切断术为控制难治性梅尼埃病患者眩晕的有效手段,对于有适应证的患者经迷路进路前庭神经切断术控     

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。     

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.     

Ischemia of the endolymphatic sac.

A decrease in vascular density in the endolymphatic sac was suspected as a factor in the pathogenesis of endolymphatic hydrops in Meniere's disease. The present study was undertaken to explore this possibility by cutting the posterior meningeal artery and the sigmoid sinus above and below the external aperture of the vestibular aqueduct or by incision of the dura adjacent to the sinus in 18 guinea pigs. The lesions in the sac were greater in the segmental ablation of the artery and sinus and were consistently associated with the development of endolymphatic hydrops. Among the lesions shown in the sac epithelia, the intermediate portion was most often and most severely affected with a decrease in rugose formation and a flattening of the tall epithelial cells or replacement of epithelial cells by squamous type cells. A high correlation between the lesions in the intermediate portion and occurrence of hydrops suggests that the intermediate portion plays a greater role in the pathogenesis of endolymphatic hydrops. The sac luminal precipitates known to be increased in human Meniere's cases were decreased or absent in this study, which suggests that the increased amount is unlikely to be the cause of endolymphatic hydrops. The evidence supports the hypothesis that these substances are secreted by the endolymphatic sac. The limited sensory cell lesions seen in the cochleae and saccules are likely to be due to a temporary vascular ischemia and endolymphatic hydrops.     

The vascular supply of the endolymphatic sac.

The vascular anatomy of the endolymphatic sac in guinea pigs was examined following intravascular injection of silicone rubber (Microfil). Methacrylate resin of low viscosity (Mercox) was used to obtain vascular corrosion casts for scanning electron microscopy, which allowed more accurate differentiation between arteries and veins. The extensive vascular system around the sac comprises both arteries and veins, as well as lymphatic vessels. The arterial supply is derived mainly from the posterior meningeal artery in the posterior cranial fossa. In some cases a small artery also leads to the sac from the posterior vestibular artery in the labyrinth (in 7 of the 35 animals investigated). It courses together with the vein of the vestibular aqueduct along the walls of the endolymphatic duct. The blood is drained over the intermediate portion of the endolymphatic sac, which becomes lodged in a rich meshwork of capillaries, venules, veins and a few small arteries. A few venous trunks from both sac walls fuse with the vein of the vestibular aqueduct, which drains blood from the vestibule to the sigmoid sinus. Scanning electron microscopy also revealed numerous anastomosing vessels within bone channels with adjacent bone marrow sinusoids, which also probably contribute to the vascular supply of the endolymphatic sac.     

The vascular pattern of the endolymphatic sac in the human embryo

The venous vascular anatomy of the endolymphatic sac in human embryos was examined. The endolymphatic sac was found to be covered by sinusoid-like blood vessels arising from the sigmoid sinus. A rich and extensive capillary network was present on the epithelial surface of the endolymphatic sac. Connections between this capillary bed and the vein in the paravestibular canaliculus were seen. The blood of the endolymphatic sac can therefore drain either into the vein of the vestibular aqueduct in the paravestibular canaliculus or directly into the sigmoid sinus. The vessels lying on the endolymphatic sac are thin-walled and irregular. The endothelial cells lies in direct contact with the epithelial cells of the endolymphatic sac. The reduction of the dense capillary bed in the young embryo to only a few vessels in the order embryo is described.