经乳突-上鼓室入路面神经减压术治疗贝尔氏面瘫

Facial nerve decompression via mastoidepitympanum approach for Bell’s palsy

摘要:

目的探讨经乳突-上鼓室入路面神经减压术治疗贝尔氏面瘫的手术指征、时机及效果。方法回顾性总结2015年1月~2017年12月在北京天坛医院耳鼻咽喉科经乳突-上鼓室入路行面神经减压术治疗的贝尔氏面瘫37例临床资料。以病程为分组标准，其中病程2个月内患者21例；病程2~3个月患者9例；病程3个月以上患者7例。对病程与术后面神经功能分级进行Spearman相关性检验，对不同病程患者术后面神经功能分级进行χ2检验。分析手术时机对患者术后面神经功能恢复的影响。结果病程在2个月以内的患者，术后7例（33.3%）恢复至HB I或II级,10例（47.6%）恢复至HB III级，4例（19.1%）为HB IV级以上；病程2~3个月的患者，术后1例（11.1%）恢复至HB I或II级,3例（33.3%）恢复至HB III级，5例（55.6%）为HB IV级以上；病程3个月以上的患者，术后1例（14.3%）恢复至HB III级，6例（85.7%）为HB IV级以上。对患者病程与术后面神经功能分级行Spearman相关性检验，差异具有统计学意义（P=0.001）。病程在3个月以内的患者手术有效率为70.0%，明显高于病程超过3个月的患者（14.3%），差异具有统计学意义（P=0.007）。结论面神经功能变性超过90%的贝尔氏面瘫患者，若保守治疗无明显改善，应在3个月内尽快选择手术治疗。面神经减压术能够有效改善这类患者的面神经功能恢复状况。

Abstract:

Abstract:ObjectiveTo study the operation indications, optimal timing and final facial function outcomes of facial nerve decompression for patients with Bell’s palsy.MethodsClinical data of 37 cases with Bell’s palsy underdoing facial nerve depression via a mastoidepitympanum approach were analyzed retrospectively. All the patients were divided into 3 groups according to the illness course, i.e. group with illness course less than 2 months(n=21), that between 2 to 3 months(n=9) and that more than 3 months(n=7). Spearman test was employed to assess the relationship between operation timing and final facial function. The effect of operation timing on postoperative facial function was analyzed via comparing the facial function among different groups by χ2 test.ResultsOf the 21 patients with illness course less than 2 months, facial function got recovered to HouseBrackmann (HB) I or II in 7 cases, HB III in 10 and HB IV or above in 4. Of the 9 cases with illness course between 2 to 3 months, facial function got recovered to HB I or II in one, HB III in 3 and HB IV or above in 5. In the 7 patients with illness course more than 3 months, 1 patient recovered to HB III, 6 to HB IV or above. The facial nerve function recovery was closely associated with the operation timing (P=0.001). The effective rate of decompression surgery in patients with illness course within 3 months was 70%, which was significantly higher than that of more than 3 months (14.3%)(P=0.007).ConclusionsFacial nerve decompression should be chosen within 3 months since onset for Bell’s palsy patients with invalid conservative treatment. Facial nerve decompression is an effective management for this disease.