静脉阻断试验在微血管减压术治疗三叉神经痛中的应用  

Role of vein occlusion test in microvascular decompression for trigeminal neuralgia

作　　者：李世亭[1] 仲骏[1] 徐顺清[1] 万亮[1] 王旭辉[1] 

机构地区：[1]上海交通大学医学院新华医院神经外科,上海200092

出　　处：《上海交通大学学报（医学版）》2008年第10期1278-1280,共3页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市教委曙光计划项目(07SG21);上海市科委重点项目(074119630)~~

摘　　要：目的为了提高静脉性血管压迫所致三叉神经痛的手术疗效和降低并发症，介绍一种处理责任静脉的方法。方法2000年8月～2007年1月间行微血管减压术（MVD）的409例三叉神经痛患者中，责任血管为静脉或动静脉混合压迫的有118例（29％），其中58例为粗大的深部引流静脉，减压前行静脉暂时阻断试验。其中试验阴性者53例，静脉予以切断减压；5例试验阳性者中3例切断，2例分离后减压。结果53例将责任静脉直接切断的患者中，术后51例症状完全缓解，2例明显减轻，但有6例出现不同程度面部麻木。5例试验阳性者中，3例切断后都因严重的小脑肿胀再行后颅窝减压术，死亡1例，另2例行分离后减压的患者术后疼痛获得明显减轻。结论暂时阻断试验可以作为处理粗大责任静脉时的一个参考依据。Objective To introduce a method for venous decompression so as to improve the operative outcomes and decrease the complications of microvascular decompression （MVD） in patients with trigeminal neuralgia compressed mainly by veins. Methods Among 409 consecutive patients with trigeminal neuralgia for MVD, there were 118 （29%） cases of venous compression or venous compression in combination with arterial compression. Before dissection, the temporal occlusion tests were performed in 58 patients with large vein compression, and the veins were coagulated and cut in 53 patients （91.4%） with negative result of occlusion test. Among the other 5 patients with positive resuhe, the vein was finally saved in 2 and cut in 3. Results Among the 53 vein-cut patients, pain free was achieved in 51 and partial pain relief was realized in 2, while facial numbness was found in 6. Among the 5 patients with positive result of occlusion test, all the 3 vein-cut patients were reoperated for posterior fossa decompression due to severe cerebellar edema, and 1 died finally. While the other 2 patients with decompression got only partial pain relief postoperatively. Conclusion The vein occlusion test can help to make decisions before manipulation of the petrosal vein during MVD.

关 键 词：岩静脉 血管暂时阻断术 三又神经痛 微血管减压术 神经电生理监测 

分 类 号：R651.3[医药卫生—外科学]