三叉神经痛立体定向外科治疗后复发的原因分析  

Analysis of Reason about Recurrence of Trigeminal Neuralgia with gamma-radiosurgery

作　　者：刘海涛[1] 陈群[1] 朱玉存[1] 杨耘[1] 郝琴[1] 

机构地区：[1]镇江市第一人民医院伽玛刀中心,镇江212002

出　　处：《立体定向和功能性神经外科杂志》2008年第6期355-358,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探索伽玛刀治疗三叉神经痛后复发的原因,以便提高手术疗效。方法回顾性分析随访285例中有26例伽玛刀治疗后疼痛复发病人,分析与年龄、性别、发病时间、是否辅助用药、靶点数、照射部位等13种因素的关系,两组或多组间计数资料的比较用Chi-square检验,Pearson法计算t值,P<0.05为有统计学意义,以寿命表法统计复发率及中位复发时间,并用Cox回归模型(center法)多因素分析,使用SPSS for Windows11.0统计软件。结果三叉神经痛的复发率为9.12%,与年龄、性别、单双侧均发病、是否有手术史、等因素不存在统计学差异(P<0.05标准),临床分型、照射部位、三叉神经根部显示清晰度、靶点数目等因素与复发组存在统计学差异(P<0.05标准)。结论三叉神经痛患者经伽玛刀治疗后的复发率为9.12%,复发中位时间为44.7个月,三叉神经痛的复发与使用的靶点数、疼痛的三叉神经支数、照射部位、三叉神经根部显示清晰度等因素有关。为了提高疗效,降低复发率,应使用双靶点、高场强磁共振,照射部位选择三叉神经根部近脑桥端(REZ)。Objective To investigate the relapse reason of the recurrence of trigeminal neuralgia patients after the Gamma-knife treatment and help the clinical doctors to improve treatment effects and reduce the danger. Methods Review the 26 cases of recurrent patients of trigeminal neuralgia after Gamma-knife radiosurgery, analyze 13 factors including age, sex, recurrent time, ether medication, the number of target points , radio position and so on. Chi-square test was used to compare the variance between or among the different groups. Pearson means were used to calculate the t value. There was significant when P〈0. 05. Recurrent rate and middle- recurrent time were analyzed by SPSS for Windows11. 0 software. Results The recurrent rate was 9. 12% and middle-recurrent time is 44. 7 months in all patients after Gamma-knife therapy. The age,sex,current both sides, ether neurosurgery were not significant between the recurrent groups and no recurrent groups（P〈0. 05）. While Clinical type, radio spot, wether indicating clearly trigeminal nerve root, target point numbers were correlative factors（P〈0. 05）. Conclusion TN recurrent factors include target points, trigeminal nerve branches, radio spot, trigeminal nerve root condition, secondary trigerninal neuralgia（STN）. Two target points, higher Tesla MRI,radio trigeminal nerve root nearly to pons could raise therapy effects and reduce recurrent rate.

关 键 词：三叉神经痛 伽玛刀 复发 原因 

分 类 号：R745.11[医药卫生—神经病学与精神病学]