[内淋巴囊-乳突分流术治疗难治性梅尼埃病的疗效]

[Efficacy of endolymphatic sac-mastoid shunt surgery for intractable Meniere's disease].

作者信息

Zhang Daogong, Fan Zhaomin, Shi Honglu, Han Yuechen, Lyu Yafeng, Li Yawei, Wang Guangbin, Wang Haibo

机构信息

Department of Otorhinolaryngology Head and Neck Surgery, Provincal Hospital Affaliated to Shandong University, Jinan 250021, China.

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出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Sep;50(9):729-32.

PMID:26696344

Abstract

OBJECTIVE

To investigate the effect and mechanism of endolymphatic sac-mastoid shunt surgery for intractable Meniere's disease of different stages according to hearing level.

METHODS

Data from 240 patients diagnosed with unilateral MD strictly meeting the criteria issued by Chinese Academy of Otolaryngology-Head and Neck Surgery Committee (2006) from January 1983 to January 2012 were analyzed in this study. Endolymphatic sac-mastoid shunt surgery was performed in affected ear for each patient. The evaluation of therapy followed the guidelines issued by Chinese Academy of Otolaryngology Head and Neck Surgery Committe. Vertigo control and auditory function were measured in two-year's follow-up.

RESULTS

According to the preoperative staging of hearing, among these 240 patients, there were 12 cases in stage I (with an average hearing threshold < 25 dB), 130 cases in stage II (with an average hearing threshold of 25-40 dB), 85 in stage III (41-70 dB) and 13 cases in stage IV(with an average hearing threshold > 70 dB). Overall control rate of vertigo was 77.9% (187/240) in two-year's follow-up, with total control 49.2% (118/240) and substantial control 28.7% (69/240). The hearing was improved in 25.0% (60/240) of cases, no change in 59.2% (142/240) of cases, and worse in 15.8% (38/240) of cases. According to different stages, vertigo control rate was 83.3% (10/12) in stage I, 82.3% (107/130) in stage II, 75.3% (64/85) in stage III and 46.2% (6/13) in stage IV. Vertigo control rate of stage IV patients was significantly lower than that of stage II and III patients (χ(2) = 9.318 and 4.692, P < 0.05), while vertigo control rate of stage I, II, III patients had no significant difference with each other (P > 0.05).

CONCLUSION

Endolymphatic sac-mastoid shunt operation is an effective method in the treatment of intractable Meniere's disease, but the effect was poor in stage IV patients.

摘要

目的

根据听力水平探讨内淋巴囊-乳突分流术治疗不同分期难治性梅尼埃病的疗效及机制。

方法

本研究分析了1983年1月至2012年1月期间240例严格符合中华医学会耳鼻咽喉头颈外科学分会（2006年）发布标准的单侧梅尼埃病患者的数据。为每位患者的患耳进行内淋巴囊-乳突分流术。治疗评估遵循中华医学会耳鼻咽喉头颈外科学分会发布的指南。在两年随访中测量眩晕控制情况和听觉功能。

结果

根据术前听力分期，这240例患者中，Ⅰ期（平均听阈<25dB）12例，Ⅱ期（平均听阈25 - 40dB）130例，Ⅲ期（41 - 70dB）85例，Ⅳ期（平均听阈>70dB）13例。两年随访中眩晕总体控制率为77.9%（187/240），其中完全控制49.2%（118/240），显著控制28.7%（69/240）。听力改善者占25.0%（60/240），无变化者占59.2%（142/240），变差者占15.8%（38/240）。根据不同分期，Ⅰ期眩晕控制率为83.3%（10/12），Ⅱ期为82.3%（107/130），Ⅲ期为75.3%（64/85），Ⅳ期为46.2%（6/13）。Ⅳ期患者眩晕控制率显著低于Ⅱ期和Ⅲ期患者（χ(2)=9.318和4.692，P<0.05），而Ⅰ、Ⅱ、Ⅲ期患者眩晕控制率差异无统计学意义（P>0.05）。