面听神经电生理监测辅助面肌痉挛显微血管减压术的临床对比分析

Clinical comparison and analysis about electrophysiological monitoring of facial and auditory nerve assisting microvascular decompression to cure hemifacial spasm

目的探讨面听神经电生理监测对面肌痉挛的临床诊断、手术操作、术后并发症及长期预后的临床指导意义。方法随机选取2009年3月未应用神经电生理技术时的30名面肌痉挛患者,另随机选取2015年3月的30名面肌痉挛患者术前、术中及术后均行神经电生理检查,所有60例患者均采用显微血管减压术,均随访12个月以上时间。对比分析神经电生理对面肌痉挛临床诊断、术中责任血管判断、术后并发症发生率及长期临床预后评估的意义。结果监测组:非典型症状2例经电生理检查确诊;术中可疑责任血管经电生理检查3例明确,6例排除。两组对比:治愈率(100%:96.7%)及迟发型面瘫(13.3%:10%)发生率无明显差异,术后听神经总体并发症的发生率电生理监测组明显下降(26.7%:6.7%,P<0.05)。结论神经电生理技术对不典型面肌痉挛的辅助诊断、术中辨别责任血管、降低术后听神经并发症率以及评估术后症状暂时未愈患者的长期预后有着重要的临床意义。

Objective To discuss the clinical guidance significance of electrophysiological monitoring of facial and auditory nerve in the diagnosis,surgical operation,postoperative complications and long-term prognosis of hemifacial spasm.Methods Randomly selecting 30 hemifacial spasm patients without neural electrophysiology in March 2009,when neural electrophysiology had not been used.And randomly selecting 30 hemifacial spasm patients with preoperative,intraoperative and postoperative neural electrophysiology in March 2015.All of the 60 patients were cured by microvascular decompression,and followed up more than 12 months.Finding the significance of neural electrophysiology in diagnosis,judging offending artery,incidencing postoperative complications and long-term prognosis of hemifacial spasm,by the clinical comparison and analysis.Results Monitoring group:2 atypical hemifacial spasm patients were diagnosed by neural electrophysiology.3 suspicious offending arteries were confirmed,and 6 were excluded in operations by neural electrophysiology.Comparison between the two groups:there were no difference in cure rate(100%:96.7%)and the incidence of delayed facial paralysis(13.3%:10%).The incidence of auditory nerve complications dropped significantly(26.7%:6.7%,P<0.05).Conclusion Neural electrophysiology have important clinical significance in diagnosing the atypical hemifacial spasm,identifying the offending artery,reducing the postoperative complication rate of auditory nerve,and assessing the long-term prognosis of patients,whose symptom were not disappeared just after operation.