Clinical characteristics and prognosis of two anastomosis techniques in the treatment of facial nerve defects
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摘要: 目的 探讨分析2种吻合术修复面神经缺损的疗效及影响因素。方法 回顾性分析2012年1月至2021年12月在我科行面神经吻合术(直接或改道)修复面神经缺损的30例患者临床资料, 其中男21例, 女9例, 平均年龄(37.53±11.33)岁, 均为单侧发病; 术前H-B Ⅳ级2例、Ⅴ级9例、Ⅵ级19例; 面瘫患者术前面瘫时间6个月以内21例, 6~12个月6例, 1年以上3例; 面瘫原因包括胆脂瘤14例、面神经肿瘤6例、外伤6例、中耳手术损伤4例。手术入路包括颅中窝入路9例, 迷路-耳囊入路8例, 乳突-上鼓室入路7例, 耳后颈侧入路6例。结果 随访2年以上。术中采用直接吻合10例: 缺损位于颞骨外段6例, 水平-锥段4例; 改道吻合20例: 缺损位于迷路-膝状神经节11例, 内听道至膝状神经节及水平段近端4例, 内听道3例, 水平-锥段2例。术后H-B面神经评分为Ⅱ级2例、Ⅲ级20例、Ⅳ级8例, 73.3%(22/30)患者能达到H-B Ⅲ级或更好。结论 面神经直接吻合术和改道吻合术均可修复面神经缺损, 2种术式疗效无明显差异。多数患者能达到H-B Ⅲ级或更好。术前面神经功能评级及术前面瘫时间是影响面神经吻合效果的主要影响因素。Abstract: Objective To investigate the characteristics and prognosis of two anastomosis techniques in repairing facial nerve defects.Methods A retrospective analysis was conducted on 30 patients who underwent facial nerve anastomosis(direct or rerouting) for facial nerve defects in our department from January 2012 to December 2021. Among them, 21 were male and 9 were female, with an average age of(37.53±11.33) years, all with unilateral onset. Preoperative House-Brackmann(H-B) facial nerve function grades were Ⅳ in 2 cases, Ⅴ in 9 cases, and Ⅵin 19 cases. The duration of facial paralysis before surgery was within 6 months in 21 cases, 6-12 months in 6 cases, and over 1 year in 3 cases. The causes of facial paralysis included 14 cases of cholesteatoma, 6 cases of facial neurioma, 6 cases of trauma, and 4 cases of middle ear surgery injury. Surgical approaches included 9 cases of the middle cranial fossa approach, 8 cases of labyrinthine-otic approach, 7 cases of mastoid-epitympanum approach, and 6 cases of retroauricular lateral neck approach.Results All patients were followed up for more than 2 years. The direct anastomosis was performed in 10 cases: 6 cases with defects located in the extratemporal segment and 4 cases in the tympanic segment. Rerouting anastomosis was performed in 20 cases: 11 cases with defects located in the labyrinthine-geniculate ganglion, 4 cases from the internal auditory canal to the geniculate ganglion, 3 cases in the internal auditory canal, and 2 cases in the horizontal-pyramid segment. Postoperative H-B facial nerve grades were Ⅱ in 2 cases, Ⅲ in 20 cases, and Ⅳ in 8 cases, with 73.3%(22/30) of patients achieving H-B grade Ⅲ or better.Conclusion Both direct and rerouting anastomosis techniques can effectively repair facial nerve defects, with no significant difference in efficacy between the two techniques. Most patients can achieve H-B grade Ⅲ or better facial nerve function recovery. Preoperative facial nerve function and duration of facial paralysis are the main prognostic factors affecting the outcome of facial nerve anastomosis.
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表 1 30例患者预后单因素Fisher精确检验分析
例 变量 术后疗效佳 术后疗效一般 χ2 P 术前H-B等级 7.902 0.012 面瘫时长 8.417 0.008 6个月以内 18 3 6~12个月 4 2 1年以上 0 3 损伤部位 6.511 0.118 多节段 1 3 内听道段 2 1 迷路-膝状神经节 8 3 水平-锥段 5 1 颞骨外段 6 0 手术方式 2.131 0.210 直接吻合 9 1 改道吻合 13 7 手术入路 4.683 0.198 乳突-上鼓室入路 6 1 迷路-耳囊入路 4 4 颅中窝入路 6 3 耳后颈侧入路 6 0 吻合方式 1.493 0.407 缝合 11 2 生物蛋白胶黏合 11 6 原发疾病 2.947 0.487 面神经瘤 4 2 胆脂瘤 9 5 外伤 6 0 医源性 3 1 术后疗效佳包括H-B Ⅱ级和Ⅲ级，术后疗效一般包括H-B Ⅳ级。 
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