半规管阻塞术与内淋巴囊减压术治疗中晚期梅尼埃病的远期疗效

Long-Term Efficacy Comparison between Semicircular Canal Occlusion and Endolymphatic Sac Decompression in Intractable Meniere's Disease

目的比较半规管阻塞术(semicircular canal occlusion,SCO)和内淋巴囊减压术(endolymphatic sac decompression,ESD)对难治性梅尼埃病(Meniere’s disease,MD)的远期疗效。方法总结129例MD患者的临床资料,其中ESD组76例,SCO组53例。比较两组术前和术后眩晕发作次数及严重程度、听力、耳鸣及耳闷等变化情况。术后随访时间为24~50个月。结果术后ESD组眩晕控制率为78.95%,SCO组为98.11%,两组比较(χ^(2)=10.025,P<0.01)。ESD组和SCO组术后眩晕严重程度评分与术前相比下降(U=8.265;8.718,P<0.01),两组相比SCO组下降更明显(U=5.163,P<0.01)。ESD组和SCO组术后残余听力保留率分别为86.84%和83.02%(χ^(2)=0.363,P>0.05)。ESD组和SCO组术后耳鸣分级都较术前下降(U=3.941,2.894>2.58,P<0.01),两组耳鸣有效率分别为55.26%和49.06%(χ^(2)=0.483,P>0.05)。ESD组和SCO组术后耳闷评分都较术前下降(U=2.495;2.305>1.96,P<0.05),两组耳闷改善率分别为43.42%和52.83%(χ^(2)=1.109,P>0.05)。结论SCO与ESD都能较好控制难治性中晚期MD眩晕发作频率和严重程度,但SCO控制眩晕的效果可能更好。SCO与ESD术后听力变化基本相同,对耳鸣和耳闷都有一定改善,但两种术式对MD术后耳鸣、耳闷的改变都没有显著差别。

Objective To compare long-term efficacy of semicircular canal occlusion(SCO)and endolymphatic sac decompression(ESD)in intractable advanced Meniere's disease(MD).Methods A total of 129 cases of intractable MD were analyzed retrospectively,including 76 treated with ESD and 53 with SCO.The frequency and severity of vertigo attacks,hearing changes,tinnitus and aural fullness were compared between the two groups.Postoperative follow-up period ranged from 24 to 50 months.Results Vertigo attacks were effectively controlled in 60 patients treated by ESD(78.95%)and in 52 patients treated by SCO(98.11%)with significantly decreased vertigo attacks(P<0.05),more so in those treated by SCO than in those by ESD(χ^(2)=10.025,P<0.01).The severity of vertigo was decreased after either ESD(U=8.265,P<0.01)or SCO(U=8.178,P<0.01)operation,more so after the latter(U=5.163,P<0.01).Residual hearing was preserved in 86.84%of cases after ESD and in 83.02%of cases after SCO,respectively(χ^(2)=0.363,P>0.05).The rate of tinnitus improvement was 55.26%after ESD and 49.06%after SCO(χ^(2)=0.483,P>0.05).Relief of aural fullness after operation was reported in both groups(U=2.495,2.305>1.96,P<0.05),43.42%after ESD and 52.83%after SCO(χ^(2)=1.109,P>0.05).Conclusion Both SCO and ESD are effective in controlling the frequency and severity of vertigo attacks in intractable MD,with SCO seemingly better in vertigo improvement.Postoperative hearing change is similar after ESD and SCO.Tinnitus and aural fullness can be similarly improved by both ESD and SCO.