内淋巴管阻塞、内淋巴囊引流和内淋巴囊减压手术在梅尼埃病内淋巴积水逆转中的比较。
A comparison of endolymphatic duct blockage, endolymphatic sac drainage and endolymphatic sac decompression surgery in reversing endolymphatic hydrops in Meniere's disease.
机构信息
Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
Department of Radiology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
出版信息
J Otolaryngol Head Neck Surg. 2021 Dec 20;50(1):70. doi: 10.1186/s40463-021-00545-7.
BACKGROUND
To explore the differences between endolymphatic duct blockage, endolymphatic sac drainage and endolymphatic sac decompression surgery in the reversal of endolymphatic hydrops (EH) in patients with intractable Meniere's disease (MD).
METHODS
A total of 27 MD patients receiving endolymphatic duct blockage surgery (n = 10), endolymphatic sac drainage surgery (n = 9) and endolymphatic sac decompression surgery (n = 8) underwent gadolinium-enhanced inner ear magnetic resonance imaging (MRI) scans prior to, 2 weeks after and at > 12 months following surgery.
RESULTS
In the group with endolymphatic duct blockage, the second MRI revealed no changes in EH, whereas the third MRI revealed a reversal of vestibular EH in 3 patients and a downgrading of cochlear hydrops in 2 of these 3 patients, who presented with an improvement in their hearing and complete control of vertigo. In the group with endolymphatic sac drainage, the second MRI showed a reversal of EH in 4 patients, and no changes in EH in the remaining 5 patients, whereas the third MRI showed that those 4 patients who presented with a reversal of EH at the second MRI stage remained unchanged except a recurrence of vestibular hydrops in 1 patient. All 4 patients exhibited a complete control of vertigo, but hearing improved in 1, worsened in 1 and remained unchanged in 2. In the group with endolymphatic sac decompression, both the second and third MRI examination revealed no reversal of EH.
CONCLUSIONS
The present study has shown that both endolymphatic duct blockage surgery and endolymphatic sac drainage surgery have the potential to reduce EH in certain MD patients, but none of the patients receiving endolymphatic sac decompression surgery showed reversal of their EH.
背景
探讨内淋巴管阻塞、内淋巴囊引流和内淋巴囊减压术治疗难治性梅尼埃病（MD）患者内淋巴积水（EH）逆转的差异。
方法
27 例接受内淋巴管阻塞手术（n=10）、内淋巴囊引流手术（n=9）和内淋巴囊减压手术（n=8）的 MD 患者在手术前、手术后 2 周和>12 个月进行钆增强内耳磁共振成像（MRI）扫描。
结果
在内淋巴管阻塞组，第二次 MRI 显示 EH 无变化，而第三次 MRI 显示 3 例前庭 EH 逆转，其中 2 例耳蜗积水降级，这些患者的听力改善，眩晕完全控制。在内淋巴囊引流组，第二次 MRI 显示 4 例 EH 逆转，其余 5 例 EH 无变化，而第三次 MRI 显示第二次 MRI 阶段 EH 逆转的 4 例患者除 1 例前庭积水复发外保持不变。所有 4 例患者眩晕完全控制，但听力改善 1 例，恶化 1 例，不变 2 例。在内淋巴囊减压组，第二次和第三次 MRI 检查均未显示 EH 逆转。
结论
本研究表明，内淋巴管阻塞手术和内淋巴囊引流术均有可能使某些 MD 患者的 EH 减少，但接受内淋巴囊减压术的患者均未出现 EH 逆转。
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