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。

Primary clinical application of semicircular canal occlusion

Objective To discuss the safety and efficacy of applying semicircular canal occlusion for treatment of positional vertigo and Meniere's disease. Methods Records of patients who had undergone semicircular canal occlusion between 1994 and 2000 were retrospectively analyzed, in which 2 patients suffered from posterior semicircular canal positional vertigo, 1 with horizontal semicircular canal positional vertigo, and 1 with recurrent Meniere's disease 5 years after endolymphatic sac-decompression. 1 was male and 3 were female, aged between 39 and 58 years. Patient with Meniere's disease underwent trisemicircular canalocclusion and endolymphatic mastoid shunt. Patients with positional vertigo underwent corresponding semicircular canal occlusion. Results Patients with positional vertigo were followed up for 1.5 to 7 years, and all patients were relieved of positional vertigo. Postoperative results of pure tone audiogram, middle ear analysis, and auditory brainstem response suggested that postoperative cochlear function were the same as preoperative. Caloric test revealed that horizontal semicircular canal occlusion eliminated its function, while in patients underwent posterior semicircular canal occlusion, function of horizontal semicircular canal representative of other vestibular end organ was preserved. The patient with Meniere's disease was followed up for 2 years after surgery, and vertigo was completely controlled. Conclusion Semicircular canal occlusion could completely control vertigo in patients with positional vertigo or Meniere's disease, and no effect on cochlear function and non-surgical semicircular canal function. Semicircular canal occlusion may become a safe and effective measure for treatment of positional vertigo and Meniere's disease.