内听道内听神经瘤残留病灶清除术中内镜技术的应用

Endoscopic technique in the removal of acoustic neuroma by retrosigmoid approach

目的 探讨乙状窦后径路听神经瘤切除术中应用内镜技术减少术后肿瘤残留发生率方面的价值和意义。方法 观察和比较常规乙状窦后径路听神经瘤切除术 (15例 )与术中使用内镜检查和切除内听道底残留肿瘤病灶 (11例 )的两组手术病人手术前后听觉、前庭功能、面神经功能和MRI检查结果。结果 常规乙状窦后径路听神经瘤切除术组病人术后有 3例发现有残留肿瘤 ,而术中使用内镜组病人均无残留 ;手术前后听觉和前庭功能障碍发生率、术后面神经麻痹发生率两组之间差异均无显著性。结论 乙状窦后径路听神经瘤切除术术中结合使用内镜非常方便和安全 ,未出现由此而引起的任何并发症 ,并可有效防止或减少单纯乙状窦后径路听神经瘤切除术后病灶的残留及肿瘤的复发 。

Objective To determine the value and significance of reducing tumor remains by endoscopic technique druing the removal of acoustic neuroma. Methods Fifteen patients proceeded the removal of acoustic tumor through retrosigmoid approach (as routine retrosigmoid-approach operation group, RRSO-G), while 11 patients were used endoscopes to inspect and eliminate the remains of tumor during the removal of acoustic neuroma through retrosigmoid approach (as retrosigmoid-approach operation combined using endoscope, RSOCE-G). All of them were examined by the auditory level, vestibular function, facial nerve function, and MRI before and after operation. Results The remains of tumor were found in 3 patients of RRSO-G but none in RSOCE-G after the operation. The rates of auditory and vestibular dysfunction, and facial paralysis showed no difference between RRSO-G and RSOCE-G. Conclusion It is safe to remove the acoustic neuroma through the retrosigmoid approach, and some degrees of hearing function are reserved at the same time. If the endoscope is used in the operation, the rate of tumor remains and neuroma recurrence rate could be reduced evidently. Removing acoustic neuroma through the retrosigmoid approach combined with endoscope is an effective method in otoneurosurgery.