目的 探讨患者术前焦虑、抑郁及睡眠质量对贝尔面瘫后遗症手术的影响及干预对策.方法 观察患者术前1 d Sunnybrook面神经评定表、焦虑自评量表(SAS)、抑郁自评量表(SDS)以及匹兹堡睡眠质量指数量表(PSQI)评分,根据术后第6个月Sunnybrook面神经评定分值将48例接受面神经茎乳孔区松解术的患者分为预后良好组(n=40)和预后不良组(n=8).比较2组SAS、SDS和PSQI评分.观察术前焦虑水平、抑郁程度、睡眠质量对手术疗效的影响.结果 预后良好组SAS、SDS和PSQI评分均低于预后不良组,差异有统计学意义(P＜0.05).患者手术疗效与术前焦虑水平、抑郁程度和睡眠质量显著相关(P＜0.05).结论 贝尔面瘫后遗症患者术前焦虑、抑郁水平和睡眠质量显著影响面神经茎乳孔区松解术的疗效,术前可对患者采取干预.

目的 探讨血清C反应蛋白(CRP)联合面神经高频超声检查对贝尔面瘫后口眼联带运动手术疗效的预测价值.方法 选取2019年6—12月于上海交通大学医学院附属新华医院颅神经疾病诊治中心接受面神经茎乳孔区松解术治疗的72例贝尔面瘫后口眼联带运动患者为研究对象.根据Sunnbrook面神经评定系统评分,将术后6个月Sunnybrook评分<30分者纳入预后不良组(n=18),将Sunnybrook评分≥30分者纳入预后良好组(n=54).比较两组患者术前血清CRP水平、面神经直径、高频超声检查结果.采用多因素Logistic回归分析探讨影响患者预后的影响因素.采用受试者工作特征(ROC)曲线分析血清CRP联合面神经超声诊断对预后的预测价值.Hosmer-Lemeshow拟合优度检测校准能力.结果 预后不良组患者术前血清CRP明显高于预后良好组,面神经直径明显大于预后良好组,两组比较,差异均有统计学意义(P<0.05).预后不良组患者面神经高回声反射比例及回声清晰度为清晰比例分别为16.7％(3/18)、33.3％(6/18),均明显低于预后良好组的88.9％(48/54)、92.6％(50/54),两组比较,差异均有统计学意义(P<0.05).血清CRP、面神经直径、回声清晰度是影响贝尔面瘫后口眼联带运动患者预后的独立危险因素(P<0.05).ROC曲线分析结果显示,血清CRP联合面神经超声诊断曲线下面积为0.88,特异度为0.86、敏感度为0.91.Hosmer-Lemeshow拟合优度检测χ2=1.86,P=0.58>0.05.结论 术前CRP联合面神经高频超声检查可有效地预测贝尔面瘫后口眼联带运动患者的手术疗效.

目的:总结面肌痉挛患者的术后并发症的发生情况并分析其原因.方法:回顾性分析了1548名在我院行微血管减压术治疗面肌痉挛的患者的临床资料,所有患者接受电话随访或者门诊随访,随访时间均超过2年,总结其临床疗效及术后并发症的发生情况.结果:微血管减压术后痊愈率及明显缓解率分别为92.5％及4.2％.249名(16.09％)患者出现不同的并发症,其中最常见的并发症为面瘫及术后手术区域皮肤感觉障碍,无死亡及重大并发症患者.听力损害发生率为3.5％.其他并发症包括脑脊液漏、后组颅神经损伤、外展神经损伤、颅内出血等.结论:微血管减压术是治疗面肌痉挛的安全有效操作,以手术区域感觉障碍及迟发性面瘫是主要的并发症,持久性的或者严重的并发症比较少见.

目的:分析短期内再次手术与射频治疗对微血管减压术后无效三叉神经痛患者的疗效差异.方法:护士通过电话随访和复诊随访方式分析2009年1月至2015年12月原发性三叉神经痛经首次三叉神经微血管减压术治疗无效54例患者(30例短期内再次手术,24例射频治疗)的疗效差异,对患者治疗后短期(术后1个月)、长期(术后1年)疼痛缓解程度及面部麻木情况进行统计,并对短期再次手术组与射频治疗组进行疗效及面部麻木的对比.结果:术后1个月,再次手术组与射频治疗组进行对比,治愈率、有效率、面部麻木率差异均有显著性(P=0.02,P=0.04,P=0.01);术后1年,再次手术组与射频治疗组进行对比,治愈率、有效率、面部麻木率、复发率差异均有显著性(P=0.004,P=0.006,P=0.02,P=0.04).结论:对于首次微血管减压术后无效的三叉神经痛患者,短期内再次手术疗效优于射频治疗,而且面部麻木发生率及复发率明显低于射频治疗.

OBJECTIVE:To investigate the methods of preoperative diagnosis and differentiation of different pathological tissue in middle ear and mastoid.METHODS:The temporal bone lamellar CT findings in 106 patients with chronic suppurative otitis media (including cholesteatoma) were retrospectively analyzed. The CT value of pathological tissue were measured for 183 times and were compared with the surgical findings and postoperative pathological findings to definitude the CT value range of different pathological tissue. Sixty patients taken from 106 patients at random were analyzed and made the diagnosis again by the same doctor team according to the CT value of the different pathological tissue and surrounding histoclasia resulted by pathological tissue. The diagnose accordance rate was compared with the routine diagnose report from radiology department. The predetective diagnosis was made in 10 patients with chronic suppurative otitis media according to clinical manifestation (pathological changes of tympanic membrane, nature of otorrhea, character of hearing), temporal bone lamellar CT finding (CT value of pathological tissue, surrounding histoclasia) to validate the value of this study for preoperative diagnosis and differentiation of different pathological tissue in middle ear and mastoid.RESULTS:The CT value of cholesteatoma, granulation tissue, cholesteatoma combined with granulation tissue, effusion, calcified tissue, thickened and polypoid membrane was respectively (46.6 +/- 10.3) Hu, (26.6 +/-7.4) Hu, (42.1 +/- 11.4) Hu, (- 24.6 +/- 9.2) Hu, (223.6 +/- 63.7) Hu, (23.8 +/- 8.5) Hu. The diagnose accordance rate in 60 patients who were analyzed and made diagnosis again according to the CT value of the different pathological tissue and surrounding histoclasia resulted by pathological tissue raised from 68. 3% to 81.7% ( P < 0.05) . The predetective diagnose accordance rate reached at 90% according to clinical manifestation, temporal bone lamellar CT.CONCLUSIONS:It was not reliable to diagnose and differentially diagnose different pathological tissue in middle ear and mastoid only by the CT value, however, the CT value could still be considered to be a very significant information. The accurate rates of diagnosis and differentiation of different pathological tissue in middle ear and mastoid obviously raised by synthetically analyzing various kinds of pathological tissues in middle ear and mastoid according to clinical manifestation, temporal bone lamellar CT finding.