人工耳蜗植入术中鼓索神经损伤的防治

Prevention and Treatment of Chorda Tympani Nerve Injury in Cochlear Implant Surgery

目的探讨人工耳蜗植入术中对鼓索神经的保护方法及鼓索神经损伤后对味觉的影响。方法回顾性分析2 005例人工耳蜗植入手术患者中13例鼓索神经损伤患者的临床资料,所有患者均采用经乳突-后鼓室-面神经隐窝径路完成人工耳蜗植入术,术中以砧骨短突作为手术标志,持续性排水冲洗下轮廓面神经垂直部及鼓索神经,使面神经及鼓索神经"透明化";分析术中鼓索神经保护技巧、损伤类型,术后予以营养神经药物(甲钴胺及盐酸氟桂利嗪胶囊)治疗后1个月及半年,应用区域性化学味阈检测法对13例患者进行味觉测试(健侧及患侧),采用视觉模拟量表(VAS,0~10分)进行味觉感知程度评分,以评估疗效。结果经术中"透明化"鼓索神经,本组仅13例发生鼓索神经损伤,发生率为0.65%(13/2 005);13例鼓索神经损伤的患者中,术中鼓索神经微触动5例,鼓索神经热损伤8例;术后第3天(治疗前)3例(23.08%,3/13)味觉丧失,7例(53.85%,7/13)味觉减退,3例(23.08%,3/13)味觉正常;治疗后1个月,13例患者中2例(15.38%,2/13)味觉丧失,8例(61.54%,8/13)味觉减退,3例(23.08%,3/13)味觉正常;术后半年1例(7.69%,1/13)味觉丧失,3例(23.08%,3/13)味觉减退,9例(69.23%,9/13)味觉正常;术后1个月及半年患者对4种化学制剂味觉灵敏程度VAS评分结果显示,术后1个月、半年患者健侧及患侧味觉差异无统计学意义(P>0.05)。结论本组人工耳蜗植入术中鼓索神经损伤发生率较低,鼓索神经损伤可导致味觉异常,术后给予营养神经药物治疗,大部分患者味觉可以恢复;术中"透明化"鼓索神经是降低鼓索神经损伤的重要保证。

Objective To study the protective methods of chorda tympani nerve during cochlear implantation,and to evaluate the effect of different damaged types of chorda tympani nerve on taste after operation.Methods The clinical data of 13 patients with tympanic nerve injury in 2005 patients with cochlear implantation were analyzed retrospectively.All patients were implanted with cochlear implant via mastoid-posterior tympanum-facial nerve recess.The short process of incus was used as the operation mark,and the vertical part of facial nerve and chorda tympani nerve were outlined to make facial nerve and chorda tympani nerve“transparent”.During the operation,normal saline was continuously washed.The protection skills and injury types of tympanic nerve during operation were analyzed.Nutritional nerve drugs(mecobalamin and flunarizine hydrochloride capsules)were given after operation.The taste of 13 patients was tested by regional chemical taste threshold test in one month and half a year after operation.Visual analogue scale(VAS,0~10)was used to score the degree of taste perception to evaluate the curative effect.Results Among 2005 case,there were 13 cases of chordae tympani nerve injury,the incidence rate was 0.65%(13/2005).Among 13 patients with tympanic nerve injury,5 cases were slightly touched by tympanic nerve during operation,and 8 cases were thermally injured by tympanic nerve.3 days after operation,3 cases(23.08%,3/13)had loss of taste,7 cases(53.85%,7/13)had loss of taste,3 cases(23.08%,3/13)had normal taste.One month after treatment,2 patients(15.38%,2/13)lost their taste,8 patients(61.54%,8/13),and 3 patients(23.08%,3/13)had normal taste.Half a year after operation,1 case(7.7%,1/13)lost taste,3 cases(23.08%,3/13)decreased taste,and 9 cases(69.23%,9/13)had normal taste.The VAS score of patients'taste sensitivity to four chemicals one month and six months after operation showed that there was no significant difference in taste between healthy side and affected side one month and six months after operation(P>0.05).Conclusion The incidence of chordae tympani nerve in cochlear implant surgery is low,and the damage of chordae tympani nerve can lead to abnormal taste.Most patients'taste can be recovered by nutritional nerve therapy after operation.Transparentization of chordae tympani nerve during operation is an important guarantee to reduce the damage of chordae tympani nerve,and continuous irrigation with normal saline during operation can reduce the occurrence of high fever damage of chordae tympani nerve.