面肌痉挛微血管减压术后并发症的相关危险因素分析  

Analysis of risk factors related to complications after microvascular decompression in patients with hemifacial spasm

作　　者：杜浩[1] 黄河[1] 宋健[1] 何远志[1] 孙荣辉[1] 丁慧超[1] 姚顺[1] 徐国政[1] 

机构地区：[1]广州军区武汉总医院神经外科,武汉430070

出　　处：《中国临床神经外科杂志》2016年第5期267-269,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨面肌痉挛微血管减压术后并发症的相关危险因素。方法对2012年至2014年治疗的148例面肌痉挛的临床资料进行回顾性分析。统计分析术后出现并发症的种类、发生率及转归,并就术前的一般情况、病程、侧别、面肌痉挛严重程度、骨窗前缘距颞骨岩部内侧面的距离、责任血管的类型及与神经根的关系、蛛网膜的增厚程度、硬膜下操作时间与术后出现并发症的相关性进行Logistic回归分析。结果 148例中,面肌痉挛术后1年缓解率为92.3%,术后均未出现严重并发症,术后2周内出现耳鸣28例(18.9%)、听力下降15例(10.1%)、面瘫12例(8.1%)、发热伴颈项强直10例(6.8%)、颅内感染2例(1.4%)。术后12个月随访,并发症发生情况为听力障碍3例、面瘫2例。骨窗前缘距颞骨岩部内侧面的距离>2 cm(OR=3.167,P=0.038)、责任血管发出穿支血管包绕神经出脑干区(OR=1.674,P=0.027)、分离血管时间>30 min(OR=1.563,P=0.042)与术后并发症的发生有显著相关性。结论面瘫和听力下降为面肌痉挛术后早期容易出现的并发症,其发生原因主要与术中责任血管的分离困难,增加血管痉挛有关,术中听神经的操作损伤也与术后耳鸣及听力下降等并发症相关。Objective To discuss the risk factors related to complications caused by microvascular decompression （MVD） in patients with hemifacial spasm （HFS）. Methods The clinical data of 148 patients with HFS treated by MVD in our hospital from January, 2012 to December, 2014 were analyzed retrospectively. The risk factors related to the complications caused by MVD were analyzed by logistic regression analysis. Results The rate of remission of HFS was 92.3% 1 year after the MVD, and there were no severe complications in all the patients. The complications occurred within 2 weeks after MVD included tinnitus in 28 patients （18.9%）, hearing loss in 15 （10.1%）, facial palsy in 12 （8.1%）, pyrexia and neck rigidity in 10 （6.8%） and intracranial infection in 2 （1.4%）. Hearing loss remained in 3 patients and other 2 patients still suffered from facial palsy 12 months after MVD. The risk factors related to the complications after MVD included the distance from the anterior edge of bone window to the interior wall of petrous bone over 2cm, the nerve root enclosed by perforate arteries arising from the responsible vessels for HFS and the responsible vessels separation duration over 30 min. Conclusions The facial palsy and hearing loss, which are not uncommon in patients with HFS after MVD, attribute to the vascular spasm and operative side-injury to the nerve during MVD.

关 键 词：面肌痉挛 微血管减压术 手术并发症 危险因素 

分 类 号：R745.12[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]