136例三叉神经周围支撕脱术止痛不全与复发因素的分析及处理  

Clinical analysis of peripheral branch evulsion of trigeminal nerves on treatment of trigeminal neuralgia:report of 136 cases

作　　者：曹放云[1] 唐西清[1] 范晓升[1] 伍协阶[1] 唐荣林[1] 唐云环[1] 

机构地区：[1]南华大学附属第二医院口腔科,湖南衡阳421001

出　　处：《上海口腔医学》2008年第2期136-139,共4页Shanghai Journal of Stomatology

摘　　要：目的:分析三叉神经周围支撕脱术后止痛不全与复发的因素及临床对策。方法:对136例三叉神经痛患者撕脱术后3a以上的临床资料进行统计,分析其术后止痛不全与复发的因素。结果:1例第Ⅰ支撕脱术,显效;78例第Ⅱ支撕脱术,显效45例,有效27例,无效6例,总有效率92.31%;91例第Ⅲ支撕脱术,显效82例,有效9例,总有效率100%。实际纳入统计的3a复发情况:1例第Ⅰ支撕脱,无复发;68例第Ⅱ支撕脱,24例复发;72例第Ⅲ支撕脱,3例复发;另6例第Ⅲ支痛的患者术后出现第Ⅱ支痛,2例第Ⅱ支痛的患者术后出现第Ⅲ支痛。结论:影响三叉神经撕脱术后止痛不全与复发的因素较复杂,治疗不彻底可能是其主要原因。临床上将转支痛与复发相混淆,也是造成三叉神经撕脱术后复发率较高的一个重要原因。眶下孔内电热凝、颊神经撕脱可减少止痛不全与复发的发生。结扎神经断端也有可能减少复发。PURPOSE： To investigate the clinical effect of peripheral branch evulsion of trigeminal nerves on trigeminal neuralgia, especially on the aspect of odynolysis and recurrence. METHODS： 136 patients with trigeminal neuralgia underwent peripheral branch evulsion of trigeminal nerves were retrospectively reviewed with three years follow-up period. The odynolysis and recurrence of pain were observed. RESULTS： Excellent effect was obtained in one patient underwent branch Ⅰ evulsion. Excellent, good, and no effect were obtained in 57.7% （45/78）, 34.6% （27/78）, and 7.7% （6/78） of patients underwent branch Ⅱ evulsion, respectively, with the total effective rate of 92.3%. Excellent and good effect was obtained in 91.1% （82/91） and 8.9% （9/91） of patients underwent branch Ⅲ evulsion, respectively, with the total effective rate of 100%. During the 3-year follow-up period, no pain recurrence occurred in the patient underwent branch Ⅰ evulsion, pain recurrence occurred in 24 out of 68 patients underwent branch Ⅱ evulsion, and in 3 out 72 patients underwent branch Ⅲ evulsion. Furthermore, pain of branch Ⅱ occurred in 6 patients underwent branch Ⅲ evulsion, and pain of branch Ⅲ occurred in 2 patients underwent branch II evulsion. CONCLUSIONS： The factors of pain recurrence and odynolysis are complicated. Clinically incomplete evulsion may be the main factor. Standard criteria are necessary for identification of pain recurrence and ectopic pain. Electrothermal treatment though infraorbital foramen, buccal nerve evulsion, and ligation of broken nerve are effective to treat odynolysis and pain recurrence.

关 键 词：三叉神经痛 神经撕脱 止痛不全 复发 

分 类 号：R651.3[医药卫生—外科学]