天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (3): 370-372.doi: 10.11958/20150045

• 应用研究 • 上一篇    下一篇

听神经瘤术后面神经功能恢复规律及肿瘤大小对其的影响

丁维亮1,蒲珂2,王宏2   

  1. 1 天津医科大学研究生院（邮编 300070）；2 天津市环湖医院神经外科
  • 收稿日期:2015-07-16 修回日期:2015-11-26 出版日期:2016-03-15 发布日期:2016-03-15
  • 通讯作者: 王宏 E-mail:dwliang.8758@163.com
  • 作者简介:丁维亮(1989)， 男， 硕士在读， 主要从事神经外科基础和临床方面的研究

The facial nerve functional recovery law after acoustic neuroma operation and the influence of tumor size on it

DING Weiliang1, PU Ke2, WANG Hong2△   

  1. 1 Graduate School of Tianjin Medical University， Tianjin 300070, China; 2 Department of Neurosurgery, Tianjin Huanhu Hospital
  • Received:2015-07-16 Revised:2015-11-26 Published:2016-03-15 Online:2016-03-15
  • Contact: WANG Hong E-mail:dwliang.8758@163.com

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摘要： 目的 探讨听神经瘤患者经显微外科手术后面神经功能恢复的规律，以及肿瘤大小对术后面神经功能的影响。方法 根据House等面神经功能分级（HB分级）方法，对经乙状窦后入路保留面神经显微外科手术切除的89例听神经瘤患者进行观察、电话随访和回顾性分析。以术后即刻、术后15天内、术后45天、术后3个月、术后6个月、术后12个月、超过12个月为时间点，探索面神经功能的恢复规律。并根据肿瘤最大直径<30mm，30-40mm ，≥40mm分组，比较不同组别患者术后早期（15天内）和远期（超过12个月）的面神经功能情况。结果 本组89例患者，听神经瘤术后15天内面神经功能最差（优秀率为52.81%），术后3个月内大部分逐渐恢复（优秀率达到80.90%），术后12个月内绝大部分可恢复到优秀水平（术后12个月优秀率达91.01%），术后1年以后面神经恢复较平稳。肿瘤最大直径<30mm的患者术后早期（15天内）和远期（>12个月）优秀率较好为82.61%和100%。肿瘤大小对术后早期（χ2=23.34,P=0.003,P<0.05）和远期（χ2=14.46,P=0.025,P<0.05）面神经功能状态有显著影响，且具有相关性，分别为早期（r=0.476，P=0.000，P<0.05）、远期（r=0.379，P=0.000，P<0.05）,肿瘤越大术后早期和远期面神经功能越差。 结论 经乙状窦后入路保留面神经显微外科手术切除的听神经瘤患者术后面神经功能早期（15天内）可能出现面神经功能恶化，但大部分可于术后3个月内恢复，几乎均可以于术后12个月内恢复。听神经瘤瘤体的大小与患者术后面神经功能密切相关，是影响术后早期和远期面神经功能的重要因素之一。

关键词: 神经瘤, 听, 面神经, 显微外科手术, 功能恢复, 随访研究, 手术后期间

Abstract: Objective To explore the facial nerve functional recovery law after resection of acoustic neuroma .And studied the influence of tumor size on postoperative facial nerve function. Methods According to the House-Brackman (HB) facial nerve function classification methods, grading 89 patients with acoustic neuroma after microsurgical resection with the retrosigmoid approach and facial nerve preservation. They were observed, follow-up with call and retrospectively analyzed. Choosing immediately , 15 days, 45 days , 3 months, 6 months, 12 months and more than 12 months after operation for the point .To explore the rule of the postoperative facial nerve functional recovery. And according to the tumor diameter < 30 mm, 30 ~ 40 mm, and ≥40mm divided into three groups. Compared the patients facial nerve function in different groups with early postoperative (within 15 days) and long-term (more than 12 months). Results The facial nerve function worst in 15 days after operation (excellence rate was 52.81%), but in postoperative 3 months most returning (excellence rate reached 80.90% ), for the most part can be restored to excellence in postoperative 12 months (excellence rate was 91.01% ), and the facial nerve recovery more smoothly after postoperative 12 months. Patients whoes tumor diameter < 30 mm have better excellence in early postoperative (rate was 82.61%) and long-term (rate was 100%). Tumor size has remarkable effect on facial nerve function in the early postoperative (χ2 = 23.34, P = 23.34, P < 0.05), and long-term (χ2 = 14.46, P = 14.46, P < 0.05) . And they are correlation, the early stage (r = 0.476, P = 0.000, P < 0.05) and long-term (r = 0.379, P = 0.000, P < 0.05) . The tumor more larger ,the postoperative facial nerve function in the early and long-term more poorer. Conclusion The retrosigmoid approach and facial nerve preservation in patients who have acoustic neuroma ,the facial nerve function in early postoperative (within 15 days) may appear deterioration, but most can be recovery in postoperative 3 months, and almost all can be recovery in 12 months. The postoperative facial nerve function closely related with the size of the tumors not only in the early postoperative (within 15 days) but also in the long-term (> 12 months), which is one of the important factors influencing the postoperative facial nerve function.

Key words: Neuroma,Acoustic, Facial Nerve, Microsurgery, Recovery of Function, Follow-Up Studies