类固醇激素在防治微血管减压术后迟发性面瘫中的作用

Steroid hormones in the prevention of delayed facial paralysis following microvascular decompression

目的通过对在我科行微血管减压术(MVD)的145例面肌痉挛术后患者进行随访,研究类固醇激素在面肌痉挛患者接受微血管减压术后防治迟发性面瘫(DFP)中的作用。方法 2009年4至6月和2010年4至5月这两段时期,面肌痉挛行微血管减压术的病例145例,随访时间为6～18个月。全部由同一组医师实施手术。术前均予以检测单纯疱疹病毒(HSV)IgG、IgM。病例分为两组:A组93人,术后未应用类固醇激素。B组52人,自术后当天开始应用类固醇激素,持续4 w。对比分析迟发性面瘫发生率。结果 A组有5例发生迟发性面瘫(5/93,5.38%),持续(56.6±37.7)d,按House-Brackmann分级,1例为Ⅳ级,2例为Ⅲ级,另2例为Ⅱ～Ⅲ级。B组有3例发生迟发性面瘫(3/52,5.77%),持续(29.3±1.2)d,3例均为II级。两组病例迟发性面瘫发生率(P=0.2895)及面瘫持续时间(P=0.2711)无显著性差异。结论类固醇激素不能防止面肌痉挛微血管减压术后迟发性面瘫的发生,但是能有效减轻迟发性面瘫程度,缩短其病程(样本少,统计学差异不显著)。

Objective To study the effect of steroid hormones in the prevention and treatment of delayed facial paralysis following microvascular decompression.Methods From April to June 2009 and from April to May 2010,145 cases of hemifacial spasm undergoing microvascular decompression were followed up for 6 to 18 months.All the operations were performed by the same medical team.Pre-operative herpes simplex virus（HSV） IgG and IgM were detected.All the cases were divided into two groups,group A（n=93） without administration of steroid hormones and group B（n=52） with administration of steroids from the day of operation for 4 w.The incidence of delayed facial paralysis was compared between groups.Results In group A,5 cases of delayed facial paralysis（5/93,5.38%） occurred,lasting for（56.6±37.7） d.According to House-Brackmann classification,there were 1 case of grade Ⅳ,2 cases of grade Ⅲ,and 2 cases of grade Ⅱ~Ⅲ.In group B,3 cases of delayed facial paralysis（3/52,5.77%） were found,lasting for（29.3±1.2） d and all three cases were grade Ⅱ.There was no significant difference in the incidence of delayed facial paralysis（P=0.2895） and duration of facial palsy（P=0.2711）.ConclusionSteroid can not prevent the occurrence of delayed facial paralysis following microvascular decompression for hemifacial spasm,but can effectively reduce the extent of delayed facial paralysis and shorten the course of disease.