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目的 探讨中耳胆脂瘤并发面瘫患者的病程和程度对术后面神经功能恢复的影响。方法 回顾性分析30例(30耳)中耳胆脂瘤并发面瘫患者的临床资料,男17例,女13例,年龄21~77岁,平均54.7±8.9岁;面瘫时间9天~5个月,其中,术前面瘫≤2个月14例,>2个月16例;术前不完全面瘫组(III-IV级)14例,完全面瘫组(V-VI级)16例;用Fisher确切概率检验方法分析术前面瘫病程和程度对术后面神经功能恢复的影响。结果30例患者中,3例行开放式乳突根治术,术中探查见面神经骨管先天性缺损,无面神经受损,术后面瘫完全恢复;27例面神经骨管受损,伴有面神经充血、水肿或肉芽形成,其中20例面神经受损部位累及鼓室段;行开放式乳突根治术和局部面神经减压术,术后14例(46.67%,14/30)面瘫恢复良好。面瘫病程≤2个月者面神经功能恢复良好率(78.57%,11/14)高于>2个月者(18.75%,3/16)(P<0.05),不完全面瘫者面神经功能恢复良好率(71.43%,10/14)高于完全面瘫者(25%,4/16)(P<0.05)。结论 本组中耳胆脂瘤并发面瘫者面神经受损多位于面神经鼓室段,开放式乳突根治术和局部面神经减压术是治疗中耳胆脂瘤并发面瘫的有效方法。术前面瘫病程越短、程度越轻,术后面神经功能恢复越好。
Objective To investigate the effect of duration and degree of facial paralysis on the recovery of facial nerve function in patients with middle ear cholesteatoma complicated by facial paralysis. Methods The clinical data of 30 cases (30 ears) with middle ear cholesteatoma accompanying facial paralysis were retrospectively analyzed. There were 17 males and 13 females, aged from 21 to 77 years (average 54.7 ± 8.9 years). The facial paralysis time ranged from 9 days to 5 months , Of which, 14 cases of facial paralysis ≤2months and 16 cases of> 2months before operation; 14 cases of incomplete facial paralysis (III-IV), 16 cases of complete facial paralysis (V-VI) Probability test to analyze the course and degree of facial paralysis before and after facial nerve function recovery. Results Of the 30 patients, 3 patients underwent radical mastoidectomy. Congenital defect of facial nerve tube was detected during operation, facial nerve injury was not found and facial paralysis was completely recovered. 27 cases of facial nerve tube injury were damaged with facial nerve hyperemia , Edema or granulation, of which 20 cases of facial nerve damage involving the tympanic segment; open mastoidectomy and local facial nerve decompression, 14 cases (46.67%, 14/30) facial paralysis recovered well. Facial palsy patients with facial nerve function recovery rate ≤2 months (78.57%, 11/14) were higher than> 2 months (18.75%, 3/16) (P <0.05) (71.43%, 10/14) than those with complete facial paralysis (25%, 4/16) (P <0.05). Conclusions This group of middle ear cholesteatoma patients with facial paralysis suffered from facial nerve damage mostly in the facial nerve tympanic segment. Open mastoidectomy and local facial nerve decompression are effective methods for the treatment of middle ear cholesteatoma with facial paralysis. The shorter the course of paralysis surgery before surgery, the less the degree, the better facial nerve function recovery.