梅尼埃病的个体化治疗及疗效评估

Individual management of Meniere's disease and evaluation of functional outcome

目的:探讨梅尼埃病的个性化临床治疗方法,评估梅尼埃病的非手术及手术疗效。方法:将所有梅尼埃病患者根据听力及生活质量情况进行分期;根据分期情况予以非手术治疗(改变生活方式、口服药物以及鼓室内注射地塞米松)、内淋巴囊减压或引流术、前庭神经切断术或迷路切除术。分析手术治疗梅尼埃病患者病史特点和手术情况;对于手术满1年以上的梅尼埃病患者进行术前术后的眩晕、听力及生活质量等疗效评价。结果:接受鼓室内注射地塞米松的梅尼埃病患者为20例,眩晕改善者占70%(14/20),耳鸣及耳闷改善率分别为41%(7/17)及36%(4/11)。手术治疗梅尼埃病共55例患者57次手术,其中内淋巴囊手术28次,前庭神经切断术26次,迷路切除术3次。术后1年的眩晕控制率为:内淋巴囊手术75%,前庭神经切断术100%。3例迷路切除术后随访2例,眩晕均消失;1例术后随访不满1年,正在观察中。结论:非手术治疗以及内淋巴囊减压或引流术可以减轻患者眩晕、改善患者的生活质量;前庭神经切断术和迷路切除术是有效控制梅尼埃病患者眩晕的手术方法;梅尼埃病的治疗需要依靠患者的眩晕分级、听力分期、生活质量以及是否存在手术禁忌证、主观愿望等诸多因素综合评估,从而制定适合个人的个体化治疗。

Objective：To investigate individual management for Meniere＇s disease and analyze outcomes of non-surgical and surgical management of Meniere＇s disease.Method：Patients with Meniere＇s disease were staged according to hearing and quality of life.The individual management according to the staging was established,including outpatient treatment（lifestyle change,medical management and intratympanic steroids）,endolymphatic sac decompression or drainage,vestibular neurectomy and labyrinthectomy.The characteristics of patients who underwent surgical management were analyzed.The functional outcomes of surgery in dizziness,hearing loss and quality of life were evaluated for 12-month postoperative follow-up.Result：Twenty patients underwent intratympanic injection of dexamethasone.Dizziness improved in 70%（14/20）,tinnitus improved in 41%（7/17）,and aural fullness improved in 36%（4/11）.There were 55 patients who underwent surgical managements for 57 times.Endolymphatic sac decompression or drainage was carried out in 27 patients for 28 times,vestibular neurectomy in 26 patients and labyrinthectomy in 3 patients.Vertigo control rate was 75% in patients with endolymphatic sac decompression or drainage,100% in vestibular neurectomy and 100% in labyrinthectomy at 12-month postoperative follow-up.Conclusion：The non-surgical management and endolymphatic sac decompression or drainage can improve vertigo and ameliorate quality of life.Vestibular neurectomy and labyrinthectomy are effective surgical managements to eliminate vertigo.The management of Meniere＇s disease depends on several factors： stages of vertigo and hearing,quality of life,surgical contraindications and subjective desire.Therefore,the management for Meniere＇s disease must be individualized for each patient.