针刺合针刀治疗周围性面神经麻痹疗效观察

目的　观察针刺合针刀治疗周围性面神经麻痹的疗效。方法　应用针刺合针刀治疗 4 0例 ,并与单纯针刺治疗 4 0例进行对照比较。结果与结论　治疗组和对照组总有效率无明显差异 ,但治疗组治愈率明显高于对照组。     

电针结合高压氧治疗面瘫38例临床观察

目的:对比电针结合高压氧与单纯电针治疗的疗效。方法:运用电针结合高压氧治疗病程在3个月以上面瘫38例,并与单纯电针治疗36例对照。结果:前者有效率97.4％,后者有效率55.6％,两组疗效差异有非常显著性意义(P<0.01)。结论:电针结合高压氧治疗顽固性面瘫效果优于单纯电针治疗。     

Use of the KTP-532 Laser in Acoustic Neuroma Surgery

The potassium titanyl phosphate (KTP-532) laser has been applied to otologic surgery with a proven record of both safety and efficacy. The aim of this study was to demonstrate the use, safety, and advantages of laser dissection in the surgical treatment of acoustic neuromas. The authors' experience with 111 patients in whom laser surgery was used in acoustic neuroma is presented, with emphasis on surgical technique employed and facial nerve functional outcome. The method of laser dissection did not result in deleterious neurologic sequelae or laser-specific complications. In addition, laser dissection afforded certain advantages to traditional techniques, especially in larger tumors. The facial nerve functional outcome as assessed by the House-Brackmann grading system revealed that 90.2% of small tumors, 72.2% of medium tumors, and 75.0% of large tumors achieved satisfactory (grades I and II) functional results. These results compare favorably with the literature describing nonlaser dissection techniques. The observations and results reported in this article demonstrate the safety of the KTP-532 laser in the posterior cranial fossa, and specific advantages that this technology may offer to the surgical armamentarium of the neuro-otologist are outlined.     

颞骨骨折性面瘫的临床和实验观察

为探讨影响颞骨骨折性面瘫预后的主要因素和面神经减压术的意义，总结分析了６４例面瘫预后的主要相关因素。制作面瘫实验西式，测定面神经骨管开放组和非开放线面神经膨胀率，并行电镜观察。结果表明，影响预后的主要因素是否行面神经减主及手术时机。骨管开放组面神经膨胀率显著大于非开放组，非开放组纤维损伤谋生时机提示早期行面神经减压术有 利于面神经功能恢复。     

面神经管裂缺处面神经组织学观察

目的探讨先天性面神经管裂处神经外膜缺陷可能引起的病理学改变。方法采用光学显微镜对美国明尼苏达大学颞骨病理实验室１５２６具颞骨连续切片的面神经颞骨全程进行组织病理学观察。结果发现先天性面神经管裂者８８５耳，其中４８耳在管裂处神经外膜缺损，其中４０耳面神经从管裂处疝出，有１３耳在管裂处形成外生性面神经鞘瘤。３耳在管裂处面神经受炎性细胞浸润。而管裂处有神经外膜覆盖的８３７耳均未见此类病变。结论面神经管裂处神经外膜的缺损是此处面神经疝出、外生性神经鞘瘤形成和面神经易于受炎症浸润的组织解剖学原因。     

颞骨内微型面神经鞘瘤病理研究

目的探讨颞骨内微型面神经鞘瘤的原发部位和病理行为。方法用光镜对８１５人（１５２６侧）颞骨连续切片进行面神经颞骨内全程组织病理学观察。结果发现未诊断的无症状微型ＡｎｔｏｎｉＡ型面神经鞘瘤１５人（１７耳），占１．８４％。依其病理行为特征分为外生性（１３耳，起自面神经管裂处神经束膜，并向管外生长）和内生性（４耳，起自面神经主干）两种类型。肿瘤起自迷路段者２耳，水平段１２耳，第二膝段１耳，垂直段２耳。结论将颞骨内面神经鞘瘤分为内生性和外生性两种类型有重要的病理和临床意义，有助于手术目的的确定和手术方法的设计     

瞬目反射正常值及初步临床应用

目的了解健康成人瞬目反射正常值及其临床应用价值。方法采用Ｅｖｏｌｕｔｉｏｎ型神经肌肉记录仪检测，表面电极直接刺激眶上神经，诱发瞬目反射（ｂｌｉｎｋｒｅｆｌｅｘ，ＢＲ）。在同侧眼轮匝肌记录出短潜伏期波（Ｒ１）和双侧眼轮匝肌记录出长潜伏期波（Ｒ２，Ｒ２’）。对２０名（４０侧）健康人和３０例患者（其中包括三叉神经疾病，面神经疾病及听神经瘤）进行瞬目反射测试。结果ＢＲ潜伏期健康成人平均值Ｒ１为１０．１ｍｓ，Ｒ２和Ｒ２’为３０．４ｍｓ和３０．７ｍｓ。患者组患侧ＢＲ各波潜伏期延长，与健侧和健康人相比较，经ｔ检验，Ｐ＜０．０１，差异有极显著性。结论测试结果表明该技术简单、可靠，对三叉神经、面神经疾病和听神经瘤的早期诊断能提供有价值的电生理测试结果。     

Facial nerve outcome in lateral skull base surgery for benign lesions

Objective: To statistically identify factors most important in affecting CN7 outcome in lateral skull base surgery for benign lesions. Study Design: A retrospective review of 217 nonmalignancy lateral skull base procedures from 1970 to 1995 at the Otology Group in Nashville. Methods: Charts were reviewed for epidemiology, histopathology, staging, type of CN7 mobilization (none, short, long, severance with reanastomosis, and resection), preoperative and postoperative CN7 function, surgery performed, and survival. Results: Average House-Brackman (HB) scores for mobilizations were as follows: short, 1.65: long, 2.74: and grafting, 4.33. Factors found to affect outcome in a statistically significant fashion were preoperative HB score, staging, type of CN7 manipulation, and surgical approach. Meningiomas were found to have a worse outcome than glomus tumors. Conclusions: Complete resection of tumors should be performed with minimal manipulation of the facial nerve based on regional anatomy and tumor anatomy. Laryngoscope, 108:1480–1484, 1998     

辽宁省2003年维持无脊髓灰质炎工作进展

目的对辽宁省2003年急性弛缓性麻痹(AFP)病例监测系统各项监测指标的完成情况进行分析,以继续保持无脊髓灰质炎(脊灰)状态。方法描述流行病学分析。结果辽宁省2003年AFP病例监测系统共报告AFP病例79例,均为排除脊灰病例,<15岁儿童非脊灰AFP病例报告发病率为1.34/10万,AFP病例48h内调查率为95%,合格粪便标本采集率为78%,粪便标本7d内送达率为92%,75d内收到随访表占73%,2003年监测指标有2项未达到世界卫生组织和卫生部的要求。结论继续加强培训和监测,提高监测系统的监测质量。     

听神经瘤切除与面神经功能的保存

目的探讨听神经瘤切除手术的面神经功能的保存.方法回顾性分析自1998年2月至2003年6月,在术中面神经监测下完成的听神经瘤切除手术48例,对三种手术进路的结果进行了比较.术前接受纯音测听、声阻抗测试、听觉脑干反应(ABR)、复合动作电位(CAP)及眼震电图(ENG)检查,并进行桥小脑角CT及MRI检查.术中皆进行面神经监测,面神经功能判断标准采用House-Brackmann(简称H-B)分级法.手术采用经迷路进路、乙状窦后进路和颅中窝进路三种.结果根据MRI结果,肿瘤限于内听道内者3耳,内听道外瘤体直径在1～2cm者8耳,2～3cm者12耳,大于3～5cm者25耳.48例中肿瘤完全切除者46例(96%),解剖学上保存面神经者47例(98%),术后7天内面神经功能达到H-B Ⅰ～Ⅱ级者达83%(40/48),其中乙状窦后进路组为84%(21/25),迷路进路组为83%(15/18),经颅中窝进路组为80%(4/5),各手术进路组之间基本相近.经乙状窦后进路组中有3例采用耳窥镜辅助下切除内听道内残存肿瘤,且完整保留面神经功能.结论听神经瘤切除术中应用面神经监测仪监测有助于提高面神经功能的保存率.耳窥镜辅助下克服了传统乙状窦后进路术式的难以完全暴露内听道内肿瘤的弊端.