人工耳蜗植入后面神经麻痹：发病率、病因及治疗结局的系统综述与荟萃分析

文献信息

中文摘要

背景： 面神经麻痹（FNP）是人工耳蜗植入（CI）后一种罕见但可能令人痛苦的并发症。虽然大多数病例是暂时性和可逆的，但由于文献报道的异质性，其真实发病率、病因因素和结局仍不清楚。
方法： 我们按照PRISMA 2020指南进行了系统综述和荟萃分析。检索了PubMed、EMBASE、Cochrane和OVID数据库，截止至2025年6月。纳入报告CI后FNP的研究。采用随机效应荟萃分析综合发病率和恢复率。使用纽卡斯尔-渥太华量表评估偏倚风险。数据用Zotero管理，分析在Python中进行。
结果： 共纳入23项研究，其中17项适合定量综合，涵盖12,536名患者和370例术后FNP病例。随机效应模型下的合并发病率为0.99%（95% CI 0.56-1.74%），存在显著异质性（I² = 93.6%）。恢复几乎完全，在大多数研究中接近100%，仅少数报告略低。主要病因机制为术后水肿和病毒再激活（HSV/VZV）。大多数病例通过皮质类固醇成功管理，而在72小时内开始皮质类固醇-抗病毒联合治疗可加速恢复。仅少数需要手术干预，包括神经减压或装置修正。
结论： 人工耳蜗植入后面神经麻痹是一种不常见的并发症，在大多数病例中是可逆的。尽管恢复率高，但报告的发病率和结局存在显著异质性，反映了研究设计、报告标准和临床管理的差异。当前证据无法就特定治疗策略的比较有效性得出明确结论。需要未来的前瞻性研究，使用标准化的诊断标准、结局定义和报告框架，以更好地阐明病因机制并优化预防和治疗方法。

英文摘要

BACKGROUND: Facial nerve palsy (FNP) is a rare but potentially distressing complication following cochlear implantation (CI). While most cases are transient and reversible, the true incidence, etiological factors, and outcomes remain unclear due to heterogeneous reporting in the literature.
METHODS: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, EMBASE, Cochrane, and OVID databases were searched up to June 2025. Studies reporting FNP after CI were included. Incidence and recovery rates were synthesized using random-effects meta-analysis. Risk of bias was assessed using the Newcastle-Ottawa Scale. Data were managed with Zotero and analyses performed in Python.
RESULTS: Twenty-three studies were included, of which 17 were suitable for quantitative synthesis, encompassing 12,536 patients and 370 cases of postoperative FNP. The pooled incidence was 0.99% (95% CI 0.56-1.74%) under the random-effects model, with substantial heterogeneity (I² = 93.6%). Recovery was almost complete, approaching 100% in most studies, with only a few reporting slightly lower rates. The main etiological mechanisms were postoperative edema and viral reactivation (HSV/VZV). Most cases were successfully managed with corticosteroids, while combined corticosteroid-antiviral therapy accelerated recovery when initiated within 72 h. Only a minority required surgical intervention, including nerve decompression or device revision.
CONCLUSIONS: Facial nerve palsy following cochlear implantation is an uncommon complication and is reversible in the majority of cases. Although recovery rates are high, substantial heterogeneity exists in reported incidence and outcomes, reflecting variability in study design, reporting standards, and clinical management. Current evidence does not allow definitive conclusions regarding the comparative effectiveness of specific treatment strategies. Future prospective studies using standardized diagnostic criteria, outcome definitions, and reporting frameworks are needed to better clarify etiological mechanisms and optimize preventive and therapeutic approaches.