半规管阻塞术治疗顽固性梅尼埃病的远期疗效

Long-term efficacy of triple semicircular canal occlusion in the treatment of intractable Meniere＇s disease

目的 观察半规管阻塞术治疗顽固性梅尼埃病的远期疗效,评估其有效性和安全性.方法 回顾性分析2010年12月至2012年7月山东大学附属省立医院49例行半规管阻塞术的梅尼埃病患者的临床资料.参照梅尼埃病的诊断依据和疗效评估（2006年,贵阳）标准,所有患者均临床诊断为单侧梅尼埃病,行规范化药物保守治疗至少1年以上,但眩晕仍反复发作.其中44例为首次手术,5例为内淋巴囊乳突引流术术后眩晕复发患者.全麻下经乳突进路行三个半规管阻塞术,术后均随访2年以上.采用纯音测听、前庭双温试验和颈源性前庭诱发肌源性电位（cervical vestibular evoked myogenic potential,cVEMP）进行听力学和前庭功能评估,通过内耳MRI膜迷路水成像观察阻塞术后膜迷路的形态学改变.结果 49例梅尼埃病患者术前按听力进行分期,Ⅱ期（平均听阈25～40 dBHL）2例,Ⅲ期（41 ～ 70 dBHL）40例,Ⅳ期（＞70 dBHL）7例.眩晕控制总有效率达100％,其中眩晕控制A级40例（81.6％）,眩晕控制B级9例（18.4％）;听力下降率为30.6％ （15/49）.术后所有患者均出现短时间眩晕及平衡障碍,眩晕均在术后3～5d内消失,平衡障碍恢复时间平均为13.5 d;所有患者均无面神经麻痹、脑脊液漏等并发症发生.术后2年复查前庭双温试验提示术侧半规管功能丧失;cVEMP检查示球囊功能无明显变化;内耳MRI膜迷路水成像检查发现三半规管阻塞区域无显影.结论 半规管阻塞术控制眩晕远期疗效确切,是治疗顽固性梅尼埃病安全、有效的方法,主要适用于存在重度以上听力损失或内淋巴囊手术后复发的患者.

Objective To explore the long-term efficacy and safety of triple semicircular canal occlusion （TSCO） in the treatment of intractable Meniere＇s disease （MD） so as to provide an alternative surgical procedure for treating this disorder.Methods Data from Forty-nine patients,who were referred to our hospital and diagnosed with unilateral MD strictly meeting the criteria issued by Chinese Academy of Otolaryngology-Head and Neck Surgery Committee （2006） from Dec.2010 to Jul.2012,were retrospectively analyzed in this work.Forty-nine patients,in whom the standardized conservative treatment was given at least one year and frequent vertigo still occurred,received TSCO.Vertigo control and auditory function were measured.Pure tone audiometry,caloric test,and cervical vestibular evoked myogenic potential （cVEMP） were performed for evaluation of audiological and vestibular function.Magnetic resonance hydrograph of inner ear was performed in patients received TSCO after 2 years for the observation of morphology of membranous labyrinth.Postoperative follow-up period was more than 2 years.Results According to the preoperative staging of hearing,among these 49 patients,there were 2 cases in stage Ⅱ （with an average hearing threshold of 25-40 dBHL）,40 in stage Ⅲ （41-70 dBHL） and 7 in stage Ⅳ （over 70 dBHL）.Vertigo was controlled effectively in all 49 cases in two-year follow-up,of which 40 cases （81.6%） were completely controlled and 9 cases （18.4%） were substantially controlled after surgery.The rate of hearing preservation was 69.4% and the rate of hearing loss was 30.6%.Post-operatively,all patients suffered from temporary vertigo and balance disorders.Vertigo was disappeared in all patients within 3-5 days,while averagely recovered after 13.5 days.Two years afer treatment,loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in cVEMP test was noted.All patients had no facial paralysis,cerebrospinal fluid leakage,and other complications.Magnetic resonance hydrograph of inner ear showed that endolymph fluid in the position of plugging had no water after 2-years of TSCO.Conclusions TSCO,which can reduce vertiginous symptoms effectively in patients with intractable MD in long-term follow-up,represents an effective and safe therapy for this disorder.TSCO is expected to be used as an alternative procedure for the treatment of MD in selected patients suffering from severe hearing loss or recurrence after endolymphatic sac surgery.