颈侧入路舌咽神经切断术治疗原发性舌咽神经痛  

Glossopharyngeal neurotomy through laterocervical approach to treat idiopathic glossopharyngeal neuralgia

作　　者：娄卫华[1] 路武豪[1] 孙慧如[1] 

机构地区：[1]郑州大学第一附属医院耳鼻咽喉科,450052

出　　处：《中华耳鼻咽喉头颈外科杂志》2008年第11期818-821,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨颈侧入路舌咽神经切断术治疗原发性舌咽神经痛的方法。方法回顾性分析12例改良的颈侧入路舌咽神经切断术治疗原发性舌咽神经痛患者的临床资料、手术方法、手术效果以及随访结果。在切断舌咽神经时应用绝缘套，在颈静脉孔顶壁烧灼损毁舌咽神经下神经节及切断鼓室支；同时切断同侧喉上神经。结果术后随访3个月～3年，随访中位时间为15个月。12例行颈侧入路舌咽神经切断术的原发性舌咽神经痛患者中，11例患者疼痛完全缓解，1例症状明显减轻，疼痛缓解率达100．0％，疼痛完全缓解率达91．7％。并发症轻微，术中出现脑脊液漏1例，明胶海绵填塞后耳脑胶粘贴，术后恢复良好；术后轻度面神经麻痹1例，1周后恢复；声音较术前略低沉1例；咽喉部异物感2例。结论颈侧入路舌咽神经切断术是治疗原发性舌咽神经痛的一种有效方法。Objective To introduce a modified laterocervical approach for glossopharyngeal neurotomy to treat idiopathic glossopharyngeal neuralgia. Methods The clinical data, the operative technique, the operative effects and （the results of） follow-up of 12 patients were presented. Through reviewing pertinent literatures, the therapeutic advancement of glossopharyngeal neuralgia and the modified technique of laterocervical approach for glossopharyngeal neurotomy were discussed. New idea on operations, of which the use of insulation coverings when cauterizing the inferior ganglion of glossopharygeal nerve and Jacobson nerve were brought. Homonymous superior laryngeal nerve was excised at the same time. Results All patients （the cases） were followed-up for 3 months to 3 years with an median of 15 months. Among the 12 patients suffered from glossopharyngeal neuralgia, 11 patients were satisfied with the outcomes and remained disease free after surgical treatment. The remission rate of pain was 100.0%, complete remission rate of pain was 91.7%. Only a few patients had complications. Intraoperative leakage of cerebrospinal fluid was obstructed with gelatin sponge and pasted with mucilage in 1 case and no complication appeared in the convalescence stage. Postoperatively, facial palsy was found in 1 case which was self-cured after a week, postoperative voice depression in 1 case, and foreign body sensation in 2 cases. Conclusions Laterocervical approach for glossopharyngeal neurotomy is an available method to treat idiopathic glossopharyngeal neuralgia.

关 键 词：舌咽神经疾病 舌咽神经 去神经支配 

分 类 号：R686[医药卫生—骨科学]