面肌痉挛显微血管减压术后听力障碍发生的相关因素分析

Factors for hearing disorder after microvascular decompression for hemifacial spasm

目的:探讨面肌痉挛(hemifacial spasm,HFS)显微血管减压(microvascular decompression,MVD)术后听力障碍的发生率及相关因素。方法:纳入205例自2015年1月至2018年1月于重庆医科大学附属第一医院神经外科诊断HFS明确并行MVD手术治疗的患者临床资料,根据术后有无听力障碍,将研究对象分为听力障碍组和无听力障碍组,比较2组患者临床资料的差异性,使用多因素logistic回归分析患者发生术后听力障碍的危险因素。结果:205例患者中发生术后听力障碍的患者有24例,发生率为11.7%。通过组间比较得出术中乳突开放、听神经物理性损伤、听神经滋养血管痉挛与术后听力障碍的发生显著相关(P<0.05);多因素logistic回归分析得出术中发生乳突开放(OR=5.495;95%CI=1.217~24.815;P=0.027)、听神经物理性损伤合并滋养血管痉挛(OR=9.158;95%CI=1.219~68.785;P=0.031)是术后发生听力障碍的独立危险因素。结论:HFS MVD术中乳突开放、听神经物理性损伤且合并内听动脉或弓形下动脉等听神经滋养血管痉挛是术后发生听力障碍的独立危险因素,术中避免打开乳突、避免损伤听神经、防止听神经滋养血管痉挛可以减少术后听力障碍的发生。

Objective:To investigate the incidence rate of hearing disorder after microvascular decompression(MVD)for hemifacial spasm(HFS)and related factors. Methods:A retrospective analysis was performed for the clinical data of 205 patients who were diagnosed with HFS and underwent MVD in Department of Neurosurgery,The First Affiliated Hospital of Chongqing Medical University,from January 2015 to January 2018. According to the presence or absence of hearing disorder after surgery,these patients were divided into hearing disorder group and non-hearing disorder group,and related clinical data were compared between these two groups. A multivariate logistic regression analysis was used to identify the risk factors for hearing disorder after surgery. Results:Of all 205 patients,24(11.7%) developed hearing disorder after surgery. The comparison between the two groups showed that intraoperative mastoid incision,physical injury of the acoustic nerve,and vasospasm of the nourishing blood vessels for the acoustic nerve were significantly associated with hearing disorder after surgery(P<0.05);the multivariate logistic regression analysis showed that intraoperative mastoid incision(OR=5.495,95%CI=1.217 to 24.815,P=0.027)and physical injury of the acoustic nerve with vasospasm of the nourishing blood vessels for the acoustic nerve(OR=9.158,95%CI=1.219 to 68.785,P=0.031)were independent risk factors for hearing disorder after MVD. Conclusion:Mastoid incision during MVD for HFS and physical injury of the acoustic nerve with vasospasm of the nourishing blood vessels for the acoustic nerve,including the internal auditory artery and the subarcuate artery,are independent risk factors for hearing disorder after MVD. The incidence rate of postoperative hearing disorder can be reduced by avoiding intraoperative mastoid incision,injury of the acoustic nerve,and vasospasm of the nourishing blood vessels for the acoustic nerve.