难治性梅尼埃病患者的外侧半规管阻塞术

文献信息

中文摘要

背景： 梅尼埃病仍然是一种存在争议的疾病，不仅在其病因和诊断方面，而且在治疗方面也是如此。约2%-5%的患者在任何药物治疗下前庭症状均无改善或无法得到控制。外侧半规管（LSCC）阻塞术可能是控制症状的一种替代方法。
方法： 连续纳入20例临床及耳神经学诊断为梅尼埃病的患者。研究了12名女性和8名男性，平均年龄51岁（范围29-72岁）。所有患者均患单侧或至少听力图上有明显单侧不对称。所有接受手术的患者均接受全身麻醉。行完壁式乳突切除术。在识别出LSCC后，使用1 mm金刚石钻头磨除半规管的骨表面，直至显露膜迷路（蓝线）。然后在外侧半规管最突出的部位，用骨蜡和骨粉的混合物阻塞该半规管2或3 mm的区域。
结果： 研究中的所有患者平均住院时间为36小时，其中10名患者需要额外用药（昂丹司琼）。所有患者均口服桂利嗪75 mg，每日一次，共10天。此后，只有4名患者继续服用倍他司汀1个月。一个月后，没有患者因眩晕而服用药物。
结论： 外侧半规管阻塞术似乎是难治性梅尼埃病患者的一种有效手术选择。

英文摘要

BACKGROUND: Meniere's disease remains a controversial condition not only in terms of its etiology and diagnosis but also its treatment. Approximately 2%-5% of patients do not improve or reach the control of their vestibular symptoms with any pharmacological therapy. Surgery of lateral semicircular canal (LSCC) occlusion could be an alternative to control the symptoms.
METHODS: Twenty consecutive patients with clinical and oto-neurological diagnosis of Meniere's disease were included. Twelve women and 8 men with a mean age of 51 years (range, 29-72) were studied. All affected with unilateral or at least marked unilateral asymmetry in audio-gram. All patients who underwent surgery received general anesthesia. Canal wall up mastoidectomy was performed. After the LSCC was identified, a bony surface of the semicircular canal was drilled using a 1 mm diamond burr until the membranous labyrinth was discovered (blue line). The canal was then blocked with a mixture of bone wax and bone dust in an area of 2 or 3 mm, at the most prominent part of the semicircular canal.
RESULTS: All patients in the study had an average hospital stay of 36 hours, of which 10 required additional medication (ondansetron). All were given 75 mg of cinnarizine orally once daily for 10 days. After that, only 4 patients continued taking betahistine for 1 month. One month later, no patients were taking medication for vertigo.
CONCLUSION: Lateral semicircular canal occlusion seems to be an effective surgical option for patients with refractory Meniere's disease.