·4··llfi_i床研究·』竺!!!!!!!!!!!!!!型!g!!蔓!!!堕!!!璺!堡!壁!!!!!!』!里!!!!!Y竺!!!!堕!!面神经瘤27例临床分析张帆1王宇澄1戴春富1迟放鲁1周梁1陈兵1李华伟1[摘要]目的:分析lli『神经瘤患者的临床表现和诊断,讨论不同部位面神经瘤手术方法的选择。方法:对1999—09—2006—12临床资料完整的27例面神经瘤患者进行回顾性研究。结果:27例面神经瘤患者经术后病理证实20例为面神经鞘膜瘤(74.1%),4例为面神经纤维瘤(14.8%),3例为面神经血管瘤(11.1%)。病程中表现为面瘫23例(85.2%);听力卜.降和耳鸣各11例(40.7%);表现为耳下肿块,且有耳痛、眩晕、耳闷、面部麻木、抽搐5例(18.5%)。24例(88.9%)CT或MRI提示为面神经来源肿瘤。24例(88.9%)累及2个或2个以上的面神经节段,其中累及乳突段处占87.5%(21/24),累及鼓室段处占70.8%(17/24),累及膝状神经节处占62.5%(15/24),累及内耳道占4.2%(1/24);只累及面神经的1个节段占11.1%(3/27)。27例均手术完整切除肿瘤,其中13例进行了同期面神经霞建术,包括11例腓肠神经移植术,1例面一舌下神经吻合术,1例面神经端端吻合术。2例在切除肿瘤的同时保留了面神经解剖结构的完整性。结论:面神经瘤是一种较少见的良行肿瘤,临床症状多样,CT、MRI等影像学检查有助于术前的讵确诊断,可根据患者的不同情况决定手术治疗的时间及方式。[关键词]面神经肿瘤;面瘫;影像学检查;神经重建[中图分类号]R745.1[文献标志码]A[文章编号]1001—1781(2010)01—0004-04Clinicalexperienceinfacialnervetumors:Areviewof27casesZHANGFanwANGYuchengDAlChunfuCHIFangluZHOULiangCHENBingLIHuawei(Departmentof0t01aryngology,EyeEarNoseThroatHospitalofFudanUniversity,Shanghai,200031,China)Correspondingauthor:WANGYucheng(Email:wychl99771@yahoo.eom.cn)Abstract0bjective:Toanalyzetheclinicalmanifestationsandthediagnosisofthefacialnervetumoraccord—ingtOtheclinicalinformation.andevaluatethedifferentsurgicalapproachesdependingontumorlocation.Method:Twenty-sevencasesoffacialnervetumorswithgeneralclinicalinformationsavailablefrom1999.9tO2006.12intheShanghaiEENTHospitalwerereviewedretrospectively.Result:Twenty(74.1%)schwannomas,4(14.8%)neuofibromas,and3(11.1%)hemangiomaswereidentifiedwithhistopathologypostoperatively.Duringthecourseofthedisease。23patients(85.2%)sufferedfacialparalysis,bothhearinglossandtinnitusaffected11(40.7%)ca—ses。5(18.5%)manifestedinfra—auricularmassandtheothersshowedsomeofotalgiaorvertigoorearfullnessorfacialnumbness/twitched.CTor/andMRIresultsin24casesindicatedthatthetumorsoriginatedfromthefacialnerve.Intra—operativefindingsshowedthat24(88.9%)easesinvolvednolessthan2segmentsofthefacialnerve。ofthese24cases87.5%(21/24)involvedthemastoidprotion,70.8%(17/24)involvedthetympanicprotion,62.5%(15/24)involvedthegeniculateganglion。only4.2%(1/24)involvedtheinternalacousticcanal(IAC),and3cases(11.1%)hadonlyonesegmentsinvolved.Inallofthese27cases,thetumorswerecompletelyexcised,ofwhichl3wereresectedfollowedbyanimmediatefacialnervereconstruction.including11suralnervecablegraft。1facialnerveend—to-endanastomosisand1hypoglossalfacialnerveend—to-endanastomosis.Tumorswereremovedwithpreservationoffacialnervecontinuityin2cases.Conclusion:Facialnervetumorisarareandbenignlesion,andhasnumerousclinicalmanifestations.CTandMRIcanhelpsurgeonstOmakearightdiagnosispreoperatively.WhenandhowtOgivethepatientsanoperationdependsonthepatientsindividually.Keywordsfacialnervetumor;facialparalysis;imagingexamination;nervereconstruction面神经瘤是一类发病率较低、较少见的肿瘤。多为良...