Thomsen J, Bretlau P, Tos M, Johnsen N J
Ann Otol Rhinol Laryngol. 1986 Jan-Feb;95(1 Pt 1):32-5. doi: 10.1177/000348948609500107.
The reason for the effectiveness of endolymphatic sac-mastoid shunt surgery in the treatment of patients with Meniere's disease is still open for debate. In a double-blind study, published in 1981, we could not demonstrate any difference between the effect of a simple mastoidectomy and a regular endolymphatic sac-mastoid Silastic sheet shunt. However, a significant reduction in symptoms could be demonstrated in both groups, and 70% of patients in both groups could be classified as successes. The patients were reexamined 3 years after surgery, and it was still not possible to demonstrate any differences between the sham and the active surgery. In this study, no significant differences between the two groups have been found at follow-up averaging 84 months, and success has been maintained in about 70% of patients. The only three failures, who have consistent vertiginous attacks, have been confined to the actual shunt group. Two patients in the active group have lost their hearing as compared with none in the sham group, and 35% of the patients have now developed bilateral disease. We believe that endolymphatic sac-mastoid shunt surgery is a nonspecific treatment modality, and we find no need for sac shunt surgery. The vast majority of the patients can be successfully treated by nonsurgical means, but we emphasize that above all the patient must be assured that in the event of persistent debilitating symptoms, a surgical solution to the problem is available.
内淋巴囊 - 乳突分流术治疗梅尼埃病患者有效的原因仍存在争议。在1981年发表的一项双盲研究中，我们未能证明单纯乳突切除术与常规内淋巴囊 - 乳突硅胶片分流术的效果有任何差异。然而，两组患者的症状均有显著减轻，两组中70%的患者可被归类为治疗成功。患者在术后3年接受复查，仍无法证明假手术组与实际手术组之间存在任何差异。在这项研究中，平均随访84个月时，两组之间未发现显著差异，约70%的患者维持了治疗成功的状态。仅有的三例治疗失败患者均持续出现眩晕发作，且均局限于实际分流术组。与假手术组无一例患者听力丧失相比，实际手术组有两名患者听力丧失，并且35%的患者现已发展为双侧疾病。我们认为内淋巴囊 - 乳突分流术是一种非特异性治疗方式，我们认为无需进行囊分流手术。绝大多数患者可以通过非手术方法成功治疗，但我们强调，最重要的是必须向患者保证，如果出现持续的使人衰弱的症状，针对该问题有手术解决方案。
