听神经瘤手术中面神经的保护和修复

Preservation and Repairment of Facial Nerve in Vestibular Schwannoma Surgery

黄琦;范宇琴;吴皓;汪照炎;杨军;张治华;

1:上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科

2:上海交通大学耳科学研究所

3:新疆医科大学第一附属医院耳鼻咽喉科

摘要
目的探讨听神经瘤手术治疗中面神经的保护和修复的方法。方法回顾性分析2004年1月至2006年12月我科收治137例听神经瘤的临床资料,其中肿瘤直径≥4.0cm的40例中(29.20%),39例采用扩大迷路径路切除肿瘤,1例耳囊径路切除;肿瘤直径2.6~4.0cm的64例(46.72%)中,经扩大迷路径路切除肿瘤57例,乙状窦后径路切除肿瘤7例;肿瘤直径1~2.5cm的30例中(21.90%),经扩大迷路径路切除肿瘤19例,乙状窦后径路切除肿瘤11例,肿瘤直径<1cm的3例(2.19%)均经颅中窝径路切除肿瘤。术中均采用面神经监测。结果听神经瘤全切除135例(98.54%),近全切除2例(1.46%);面神经解剖保留110例(80.3%),断离27例,全部为桥小脑角段,其中15例采取面-舌下神经吻合,6例腓肠神经移植面神经桥接吻合,6例因缺损长、术中兼有后组颅神经损伤,而未能修复。术后1周面神经功能达到H-B分级Ⅰ-Ⅱ级84例(61.3%,84/137),Ⅲ-Ⅳ级38例(27.7%,38/137),Ⅴ-Ⅵ级15例(10.95%,15/137)。术后6~12月面神经功能Ⅰ-Ⅱ级84例(61.3%,84/137),其中肿瘤≥4.0cm(5/40),肿瘤2.6~4.0cm者46例(71.86%,46/64);肿瘤1~2.5cm者30例(100%,30/30);肿瘤<1cm者3例(100%,3/3);Ⅲ-Ⅳ级者47例(34.31%,47/137),其中,肿瘤≥4.0cm29例,肿瘤2.6~4.0cm18例;Ⅴ-Ⅵ级者6例(4.35%,6/137):肿瘤均≥4.0cm。结论听神经瘤手术中面神经的保护与肿瘤的大小、面神经的走行、术前放疗、手术径路及术者的操作技巧等相关,术中采用持续面神经监测,可提高面神经的解剖保留,继而提高面神经功能保存率。面神经的修复应视面神经断离的部位、距离及后组颅神经的损伤情况来选择修复方法。
关键词
听神经瘤;面神经;保护;修复
基金项目(Foundation):
国家自然科学基金(30801286,2009-2011)、(30973307,2010-2012)资助
作者
黄琦;范宇琴;吴皓;汪照炎;杨军;张治华;
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