三叉神经根表层神经束切断术治疗三叉神经痛的研究  

Surface tractotomy of trigeminal nerve sensory root:a new tractotomy for the treatment of trigeminal neuralgia

作　　者：江远仕 杨伟炎[2] 钟世镇[3] 黄宗青 庄俊汉 张长椿[5] 陈锦生[6] 韦培涌[7] 

机构地区：[1]深圳市第四医院耳鼻咽喉头颈外科,深圳518033 [2]中国人民解放军耳鼻咽喉头颈外科研究所 [3]南方医科大学临床解剖学研究所 [4]深圳市第四医院神经内科 [5]汕头市中心医院麻醉科 [6]潮州市中心医院耳鼻咽喉科 [7]汕头大学医学院解剖学教研室

出　　处：《临床耳鼻咽喉头颈外科杂志》2010年第16期721-724,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：广东省自然科学基金资助项目(No:04012155)

摘　　要：目的:探讨三叉神经感觉根(TNSR)表层神经束切断术(STS)治疗三叉神经痛(TN)的可行性。方法:对7例TN患者实施STS,随诊4.8～9.8年,并进行三叉神经根的组织学研究。结果:全部患者术后痛觉消失,1例术后意外死亡,6例痊愈;组织学显示,典型的TNSR出脑干后纤维平行排列,3～6mm后从外周开始换鞘膜,分叉并渐向中央区域扩展,形成TNSR表层的小神经纤维束与中央区域的巨束纤维。结论:环行切断TNSR的表层纤维束可根治TN,并保留神经的其他功能,组织学研究显示其可行性。Objective：To evaluate the feasibility of surface tractotomy of trigeminal nerve sensory root（STS） for the treatment of trigeminal neuralgia（TN）.Method：Seven patients with TN were operated on using the STS. The six patients were followed up for 4.8-9.8years.The trigeminal nerve root（TNR）obtained from 30cadavers were performed microanatomical research using paraffin embedding and hematoxylin-eosin staining technique.Result：Clinically,the patients＇symptoms,such as face ache,disappeared after the surface nerve fiber bundles of trigeminal nerve sensory root （TNSR）were cut off.Only one patient died of brainstem bleeding on postoperative day 18.Histological examination：The common type of sensory root fibers were arranged parallel for 3-6mm at its exit of brainstem,and then the glial myelin transformed to Schwann cells.The axon bifurcated from outer layer to middle region,and gradually formed the tiny nerve fiber bundles in the surface layer and the giant nerve fiber bundles in the center of the root.Conclusion：TN can be radical cured by STS without lesioning of nerve functions. Therefore,this new approach is an effective,advanced surgical technique for TN treatment.

关 键 词：三叉神经痛 三叉神经 外科手术 解剖 

分 类 号：R745.11[医药卫生—神经病学与精神病学]