三叉神经痛责任血管术中判定及手术疗效  

Intraoperative decisions and surgical efficacies of trigeminal neuralgia responsible vessels

作　　者：任崇文[1] 曲春城[1] 王志刚[1] 王成伟[1] 魏胜程[1] 赵旭[1] 孟庆虎[1] 于锐[1] 

机构地区：[1]山东大学第二医院神经外科,济南250033

出　　处：《中华医学杂志》2013年第19期1482-1485,共4页National Medical Journal of China

摘　　要：目的探讨原发性三又神经痛责任血管的类型及显微血管减压术的疗效。方法回顾分析2004年8月至2012年12月山东大学第二医院162例行显微血管减压手术治疗的原发性三又神经痛患者的临床资料，162例中男69例，女93例，年龄22～88岁。结果最常见的责任血管依次为小脑上动脉65例（40．12％）、小脑前下动脉45例（27．78％）、多支血管26例（16．05％）、小脑后下动脉16例（9．88％）、静脉6例（3．70％）、椎动脉4例（2．47％）；压迫部位位于三叉神经根部139例（85．80％），远端16例（9．88％）、根部及远端同时压迫7例（4．32％）；术后162例患者疼痛全部消失（其中1例为2次手术）。随访132例，术后8年内复发2例，复发率1．52％。结论显微血管减压术是药物难控性原发性三叉神经痛的首选方法，疗效的关键是责任血管的辨认及处理，多支血管压迫、静脉压迫及远端压迫应予以重视。Objective To explore the types of primary trigeminal neuralgia （TN） responsible vessels and curative efficacies of microscopic vascular decompression （MVD）. Methods A total of 162 primary TN patients underwent MVD from August 2004 to the present at our hospital. Their clinical data were collected and analyzed. There were 69 males and 93 females with an age range of 22 - 88 years. Results The most common responsible vessels were superior cerebellar artery （ n = 65, 40. 12% ） , anterioinferior cerebellar artery （n = 45,27.78% ）, multiple vessels （n = 26, 16. 05% ）, posterioinferior cerebellar artery （ n = 16, 9.88% ） , veins （ n = 6, 3.70% ） and vertebral artery （ n = 4, 2.47% ）. And the pressure points were at the root of trigeminal nerve （n = 139, 85.80% ）, distal part （n = 16, 9. 88% ） and root and distal part （ n = 7, 4. 32% ）. Postoperatively pain disappeared in all patients （ including one case on second surgery）. Postoperative follow-ups were conducted for 132 cases. Two cases recurred over 8 years and the recurrence rate was 1.52%. Conclusion MVD is preferred method for primary TN non-responsive to pharmacotherapy. Identification and treatment of responsible vessels remain a key. Venous and distal pressure points should be taken care.

关 键 词：三叉神经痛 责任血管 微血管减压术 

分 类 号：R651[医药卫生—外科学]