人工耳蜗植入术中鼓索神经损伤的防治

Prevention and Treatment of Chorda Tympani Nerve Injury in Cochlear Implant Surgery

蒋玉欢;华清泉;

1:武汉大学人民医院耳鼻咽喉头颈外科

摘要

目的探讨人工耳蜗植入术中对鼓索神经的保护方法及鼓索神经损伤后对味觉的影响。方法回顾性分析2 005例人工耳蜗植入手术患者中13例鼓索神经损伤患者的临床资料,所有患者均采用经乳突-后鼓室-面神经隐窝径路完成人工耳蜗植入术,术中以砧骨短突作为手术标志,持续性排水冲洗下轮廓面神经垂直部及鼓索神经,使面神经及鼓索神经"透明化";分析术中鼓索神经保护技巧、损伤类型,术后予以营养神经药物(甲钴胺及盐酸氟桂利嗪胶囊)治疗后1个月及半年,应用区域性化学味阈检测法对13例患者进行味觉测试(健侧及患侧),采用视觉模拟量表(VAS,0～10分)进行味觉感知程度评分,以评估疗效。结果经术中"透明化"鼓索神经,本组仅13例发生鼓索神经损伤,发生率为0.65%(13/2 005);13例鼓索神经损伤的患者中,术中鼓索神经微触动5例,鼓索神经热损伤8例;术后第3天(治疗前)3例(23.08%,3/13)味觉丧失,7例(53.85%,7/13)味觉减退,3例(23.08%,3/13)味觉正常;治疗后1个月,13例患者中2例(15.38%,2/13)味觉丧失,8例(61.54%,8/13)味觉减退,3例(23.08%,3/13)味觉正常;术后半年1例(7.69%,1/13)味觉丧失,3例(23.08%,3/13)味觉减退,9例(69.23%,9/13)味觉正常;术后1个月及半年患者对4种化学制剂味觉灵敏程度VAS评分结果显示,术后1个月、半年患者健侧及患侧味觉差异无统计学意义(P>0.05)。结论本组人工耳蜗植入术中鼓索神经损伤发生率较低,鼓索神经损伤可导致味觉异常,术后给予营养神经药物治疗,大部分患者味觉可以恢复;术中"透明化"鼓索神经是降低鼓索神经损伤的重要保证。

关键词

人工耳蜗植入;鼓索神经;味觉

基金项目(Foundation):

作者

蒋玉欢;华清泉;

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人工耳蜗植入鼓索神经味觉

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蒋玉欢华清泉