磨除内听道在听神经瘤手术中的意义

目的 探讨听神经瘤术中磨除内听道的方法及其对面神经保护和手术疗效的意义。方法 2007年10月至2013年9月显微手术治疗听神经瘤53例，其中27例术中磨除内听道（磨除组），26例术中未磨除内听道（未磨除组）。术后随访1年，按House-Brackmann（H-B）分级评估面神经功能。结果 磨除组肿瘤全切除24例（88.9%），次全切除2例，大部分切除1例；未磨除组全切除16例（61.5%），次全切除5例，大部分切除5例；磨除组全切除率明显高于未磨除组（P<0.05）。磨除组术后1年面神经功能良好率（85.2%，23/27；H-B分级Ⅰ~Ⅱ级）明显高于未磨除组（57.7%，10/26；P<0.05）。结论 术中充分磨开内听道后壁，对听神经瘤全切除、面神经功能保护以及提高患者术后生活质量具有重要的意义。

Value of rubbing off the posterior wall of internal auditory meatus to surgery for acoustic neuromas

Objectives To study a method to rub off the posterior wall of internal auditory meatus, and analyze its clinical value to the preservation of the facial nerve during surgery for the acoustic neuromas. Methods The clinical data of 53 patients with acoustic neuromas, of whom 27 (observed group) underwent the rubbing off the posterior walls of internal auditory meatuses during the microsurgery for the tumors from October, 2010 to September, 2013 and 26 (control group) not from October, 2007 to September, 2010, were analyzed retrospectively. The curative effects of both the operative Methods on the tumors were analyzed. Results Of 27 patients in the observed group, 24 (88.9%) received the total resection of the tumors, 2 (7.4%) subtotal, and 1 (3.7%) in great part. Of 26 patients in the control group, and 16 (61.5%) received total resection of the tumors, 5 (19.2%) subtotal and 5 (19.2%) in great part. The good rates of facial nerve function were 88.8% (24/27), 40.74% (11/27), 48.15% (13/27) and 85.19% (23/26) respectively immediately, 7 days, 6 months and 1 year after the operation in the observed group. The good rates of facial nerve function were 84.62% (22/26), 30.77% (8/26), 42.31% (11/26) and 57.69% (15/26) respectively immediately, 7 days, 6 months and 1 year after the operation. The rate of total resection of the tumors and the good rate of function of the facial nerve were significantly higher in the observed group than those in the control group (P<0.05). Conclusion The adequately rubbing off the posterior wall of internal auditory meatus is of the important value to the total resection of the tumor and protection of facial nerve function in the patients with acoustic neuromas undergoing the microsurgery.