医源性面瘫的手术治疗

doi:10.6040/j.issn.1673-3770.1.2019.054

山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (1): 20-24.doi: 10.6040/j.issn.1673-3770.1.2019.054

医源性面瘫的手术治疗

田雨鑫,王菁菁,王慧,吴雅琴,时海波,陈正侬*()

上海交通大学医学院附属第六人民医院耳鼻咽喉头颈外科, 上海 200233

收稿日期:2019-09-18 出版日期:2020-01-20 发布日期:2020-03-06
通讯作者: 陈正侬 E-mail:jassey@126.com
作者简介:陈正侬，上海交通大学医学博士、硕士研究生导师、附属第六人民医院耳鼻咽喉头颈外科主任医师。致力耳聋及侧颅底疾病的基础与临床研究工作，擅长侧颅底、耳科疾病的诊治，专注耳科、耳神经外科及颅底外科相关手术的优化解决、方案提升。曾于2008年赴德国维尔茨堡大学进修耳科手术技术，2012年赴意大利世界著名颅底外科中心Gruppo Otologico学习颅底外科手术。学术兼职：中华医学会耳鼻咽喉头颈外科学分会青年委员会副主任委员、中国医师协会显微外科分会耳神经及侧颅底显微修复委员会主任委员、中国医疗保健国际交流促进会耳鼻咽喉头颈外科分会青年委员会副主任委员、中华医学会上海分会耳鼻咽喉科学会青年委员。奖项荣誉：上海市科技进步一等奖1项(第5完成者)、科技进步二等奖1项(第3完成者)、中国医师协会耳鼻咽喉科分会优秀青年医师。学术成果：承担国家自然科学基金3项；入选上海市浦江人才计划；发表SCI论文32篇，其中第一及通讯作者18篇；主译医学专著《听神经瘤显微外科手术图谱》《颅底副神经节瘤显微外科手术》。担任《中华耳科学杂志》编委、《中华医学杂志英文版》通讯编委、《中华耳鼻咽喉头颈外科杂志》通讯编委

Surgical treatment of iatrogenic facial paralysis

Yuxin TIAN,Jingjing WANG,Hui WANG,Yaqin WU,Haibo SHI,Zhengnong CHEN*()

Department of Otolaryngology Head and Neck Surgery, Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China

Received:2019-09-18 Online:2020-01-20 Published:2020-03-06
Contact: Zhengnong CHEN E-mail:jassey@126.com

摘要/Abstract

摘要： 目的

报道医源性面瘫的手术治疗经验，探讨其发生原因、处理措施及治疗效果。

方法

对2015~2017年行手术治疗的21例医源性面瘫患者的临床资料进行回顾性分析。

结果

10例中耳手术致面瘫患者，术中探查发现面神经损伤位于水平段7例，锥段2例，垂直段1例，根据面神经损伤程度，术中行面神经减压术7例，面神经-耳大神经移植术3例；11例听神经瘤切除术后面瘫患者，均行面神经-舌下神经吻合术。所有患者随访1年，面神经功能恢复至HB-Ⅲ级以内者为16例，约占76%。

结论

尽管科技发展降低了面神经损伤的概率，但医源性面瘫仍时有发生。完善的解剖知识和正确的操作技术，对于医源性面瘫的预防十分重要，一旦发生提倡早发现、早治疗，予以正确的处理方式可获得面神经功能的较好恢复。

关键词: 医源性面瘫, 中耳手术, 手术治疗, 疗效

Abstract: Objective

To evaluate the surgical treatment of iatrogenic facial paralysis and discuss its cause, treatment and therapeutic effect.

Methods

A retrospective study of 21 iatrogenic facial paralysis cases who underwent ear surgery in the ear, nose, and throat (ENT) Department between 2015 and 2017.

Results

Of those that underwent middle ear surgery, 10 iatrogenic facial nerve injuries cases were observed in the following segments: the horizontal segment in 7 cases, the pyramidal segment in 2 cases, and the vertical segment in 1 case. After evaluating the degree of damage, decompression was performed in 7 cases, and facial nerve-great auricular nerve transplantation in 3 cases. The other 11 cases with facial paralysis after acoustic neuroma surgery underwent hypoglossal-facial anastomosis. Sixteen cases (about 76%) achieved HB Ⅰ-Ⅲ one year after surgery.

Conclusions

Although scientific and technological developments have reduced the probability of facial nerve injuries, iatrogenic facial paralysis cannot be entirely avoided. Clinical doctors need to have excellent anatomical knowledge and correct operation technique to prevent iatrogenic facial paralysis. Once iatrogenic facial paralysis occurs, early diagnosis and treatment are required to achieve ideal outcomes of patients' facial nerve function.

Key words: Iatrogenic facial paralysis, Middle ear surgery, Surgical treatment, Therapeutic effect

中图分类号:

R764

田雨鑫,王菁菁,王慧,吴雅琴,时海波,陈正侬. 医源性面瘫的手术治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 20-24.

Yuxin TIAN,Jingjing WANG,Hui WANG,Yaqin WU,Haibo SHI,Zhengnong CHEN. Surgical treatment of iatrogenic facial paralysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 20-24.

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参考文献 21

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损伤原因	例数	术前面神经功能	手术治疗时机	术后面神经功能
中耳手术
乳突改良根治术	9	Ⅳ级7例	一周内	Ⅰ级2例
		Ⅴ级1例		Ⅱ级5例
		Ⅵ级1例		Ⅲ级1例
				Ⅳ级1例
人工耳蜗植入术	1	Ⅳ级1例	一周内	Ⅰ级1例
听神经瘤切除术	11	Ⅴ级6例	保守治疗半年至一年，面神经功能无改善后	Ⅲ级7例
		Ⅵ级5例		Ⅳ级4例

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医源性面瘫的手术治疗

Surgical treatment of iatrogenic facial paralysis

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