面神经周围微血管丛分布的临床研究

Clinical research about the distribution of perineural vascular plexus of the facial nerve

目的为尽可能避免医源性面神经麻痹，评估面神经水平段周围微血管丛是否可以作为耳显微或耳神经外科术中面神经的定位标志。方法从2002年7月至2005年7月，共311例因慢性中耳炎、周围性面神经麻痹以及外耳道闭锁合并中耳畸形者，分别行开放式鼓室成形术（291例）、面神经减压术（10例）和先天性耳道闭锁和中耳畸形手术（10例）。观察和评估水平段面神经周围的微血管丛作为术中定位面神经的手术标志的有效性。结果在全部病例中，有95．8％的病例（298例）手术中可满意地观察到水平段面神经周围微血管丛，位于面神经鼓室段表面，仅4．2％的病例（13例）难以在水平段面神经周围发现该微血管丛。用面神经微血管判断水平段面神经管阳性率的95％可信区间为93．6％～98．0％。结论围绕在水平段面神经周围或表面的微血管丛，可作为术中及早且直接定位面神经的手术标志，用它来迅速确定面神经水平段是可靠的。

Objective To objectively evaluate the usefulness and the reliability of the perineural vascular plexus as a landmark for facial nerve as well as whether it will be a landmark for identification of the facial nerve in surgery for otology and neurotology by means of investigating the location of the facial nerve for prevention of iatrogenic facial palsy. Methods Prospective case series were designed. Three hundred and eleven consecutive patients were studied which required tympanoplasty for chronic otitis media or microsurgery for facial nerve decompression and congenitally malformation of the ear from July 2002 to July 2005. All the patients were operated by the first author. Perineural vascular plexus as a landmark for identification of the facial nerve in surgery were observed to assess the utility. Results The well recognized perineural vascular plexus were seen on the horizontal mesotympanic segment of the nerve in 95.8% of patients （298 cases）, and only in 4. 2% of the patients （13 cases）, the vessel plexus was difficult to identify. The 95% confidence interval was from 93.6% to 98.0%. Conclusions The vascular plexuses around or over the horizontal portion of the facial nerve provide an early and direct indicator of the location of the facial nerve. The perineural vascular plexus could be a dependable and reliable landmark for the identification the horizontal part of the facial nerve in surgery for otology and neurotology.