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目的:探讨中耳乳突术中面神经裸露发生率、部位及相关因素。方法:对经乳突手术的315耳(胆脂瘤中耳炎217耳,慢性化脓性中耳炎98耳)的临床资料进行回顾性分析,分析面神经裸露发生率及部位,并选择性别、年龄、手术史、术前面瘫、术前并发症、病理类型、外半规管裂、脑膜暴露、乙状窦暴露等9项临床因素进行单因素及多因素Logistic回归分析。结果:315耳中面神经裸露共72耳,总发生率为22.9%,最常见发生部位是鼓室段(93.1%)。单因素分析显示,与面神经裸露相关的因素有术前面瘫、术前并发症、病理类型、半规管裂、脑膜暴露;多因素分析显示,与面神经裸露相关的因素有术前面瘫、病理类型为胆脂瘤、外半规管裂。结论:在乳突根治术中面神经裸露率可高达22.9%,最常见发生部位是鼓室段,术中应小心避免损伤。术前面瘫、病例类型为胆脂瘤、外半规管裂是存在面神经裸露的危险因素,可用于初步估计乳突手术中面神经裸露发生风险的高低。
Objective: To investigate the incidence, location and related factors of facial nerve in middle ear mastoid process. Methods: 315 through mastoid surgery ears (ear 217 cholesteatoma, chronic ear 98 otitis media) clinical data were analyzed retrospectively analyzed the incidence of facial nerve exposed and location, and select the gender, age, history of operation, Preoperative facial paralysis, preoperative complications, pathological type, external semicircular canal fissure, meningeal exposure, sigmoid sinus exposure and other 9 clinical factors were analyzed by single factor and multivariate Logistic regression. Results: There were 72 ears exposed in 315 ears. The total incidence was 22.9%. The most common site was tympanic segment (93.1%). Univariate analysis showed that facial paralysis associated with facial nerve paralysis, preoperative complications, pathological types, semicircular canal fissure, meningeal exposure; multivariate analysis showed that the facial nerve numbness related factors are paralyzed before surgery, the pathological type of gallbladder Lipoma, the outer semicircular canal fissure. Conclusion: In the radical mastectomy, the bare rate of facial nerve can reach as high as 22.9%. The most common site is the tympanic segment. Care should be taken to avoid the injury during operation. Preoperative paralysis, the type of cholesteatoma cases, the outer semicircular canal rupture is the presence of facial nerve exposed risk factors can be used to initially estimate the degree of facial nerve bare exposure in mastoid surgery.