鼓室成形术后主观味觉变化及术中鼓索神经不同处理方式的效果

Subjective gustatory outcome in tympanoplasty and the strategy to protect Chorda tympani nerve

目的调查鼓室成形术后鼓索神经(CTN)的损伤情况及味觉相关功能的改变和预后。探讨采取特定措施减轻CTN损伤的效果。方法前瞻性调查125例鼓室成形术患者在手术后短期和长期特定主观味觉症状的发生率,术后短期味觉功能的主观视觉模拟评分。根据是否采取CTN保护措施分成两组,再根据损伤状态交叉分组,并进行统计学比较。结果通过采取三种保护CTN的措施,神经损伤率显著降低(P=0.005)。在损伤小和损伤较大的组之间,术后短期味觉症状的发生率有统计学意义(在味觉异常、味觉减弱、舌麻木三种症状中,P值分别为0.02、0.000、0.000)。但在术后1年及以上时,以上症状几乎全部恢复正常。结论在鼓室成形术中,应采取措施尽可能保护CTN功能。当保全CTN与清除炎症发生矛盾时,可牺牲CTN,随之产生的症状可以术后远期得到缓解和痊愈。

Objective To investigate the taste disorders and outcomes after tympanoplasty in shortterm and long-term postoperatively, and study the effectiveness of three strategies to prevent Chorda tympani nerve （CTN） injured from surgical manipulation. Methods Documented the prevalence of post-operative taste disturbances, and self-describe visual analog score for taste function in 125 patients who accepted tympanoplasty; adopted three measures to prevent CTN from injury by chance, compared statistically the taste outcome between the group with the special protection and the group without them. Results Owing to adopting special protection to CTN, the unexpected injury to CTN is declined （ P = 0. 005 ）. The prevalence of short-term post-operative taste disorders among three groups （gentle touch, stretch, cross-section） are different significantly（P = 0.02,0. 000,0. 000）. Whereas most of the taste disorders are recovery after one year pest-operatively. Conclusions It is possible to save CTN from damage when some special techniques were applied in most of tympanoplasty. When it is an obstacle for CTN to eliminate the inflammation at middle ear, it should be saerifieed, and most of the subsequent taste disorders will be recovery as time flow.