X线引导经卵圆孔及周围支注射阿霉素治疗原发性三叉神经痛的临床价值：与三维CT比较  

Clinical value of adriamycin injection via foramen ovale and around peripheral trigeminal branches under guidance of X-ray for treatment of primary trigeminal neuralgia： a comparison with three-di- mensional CT

作　　者：张忠[1] 刘继强[1] 翟建亮 田立东[1] 郑宝森[2] 马文庭[3] 

机构地区：[1]天津市武清区人民医院疼痛科,301700 [2]天津市第一中心医院疼痛科,300192 [3]天津医科大学第二附属医院疼痛科,300211

出　　处：《中华麻醉学杂志》2017年第5期524-527,共4页Chinese Journal of Anesthesiology

基　　金：天津市卫生局科技基金（2014KZ131）

摘　　要：目的 通过与三维CT比较，评价X线引导经卵圆孔及周围支注射阿霉素治疗原发性三叉神经痛的临床价值。方法 原发性三叉神经痛患者91例，性别不限，年龄33～76岁，病程6月～24年，VAS评分6～9分。采用随机数字表法分为2组：X线组（n＝43）和CT组（n＝48）。2组均采用Hartel前入路行卵圆孔穿刺。眶上孔、眶下孔、卵圆孔注射0.5%阿霉素0.2、0.3和0.5 ml。治疗后1年内疼痛缓解欠佳（VAS≥4分）时，口服奥卡西平及辅助用药（曲马多、氟哌噻吨美利曲辛等）。记录治疗后1 d～1周、1周～1个月、1～3个月、3～6个月及6个月～1年，奥卡西平及辅助用药情况。记录手术时间、穿刺次数、治疗期间及治疗后1年内并发症发生情况和复发情况。结果 与CT组比较，X线组穿刺次数增多，治疗过程中面部血肿发生率升高（P〈0.05或0.01），手术时间、奥卡西平和辅用药的使用率、治疗过中头晕、恶心呕吐发生率差异无统计学意义，治疗后咀嚼肌无力和面部麻木发生率、复发率比较差异无统计学意义（P〉0.05）。结论 与三维CT比较，X线引导经卵圆孔及周围支注射阿霉素治疗原发性三叉神经痛的疗效和安全性无明显差异，表明X线引导有显著临床价值。Objective To evaluate the clinical value of adriamycin injection via the foramen ovale and around peripheral trigeminal branches under the guidance of X-ray for treatment of primary trigeminal neuralgia by comparison with the three-dimensional computed tomography（CT）.Methods A total of 91 patients with primary trigeminal neuralgia of both sexes, aged 33-76 yr, with the course of disease 6 months-24 yr, with visual analogue scale score of 6-9, were divided into 2 groups using a random number table： X-ray group（n=43）and CT group（n=48）. Hartel anterior approach was used to puncture the foramen ovale in 2 groups.One point five percent adriamycin 0.2, 0.3 and 0.5 ml were injected via the supraorbital foramen, infraorbital foramen and oval foramen.When pain relief was poor（visual analogue scale score≥ 4）within 1 yr after treatment, oxcarbazepine and adjuncts（tramadol, flupentixol and melitracen tablets, etc.）were taken orally.The requirement for oxcarbazepine and adjuncts was recorded during 1 day-1 week, 1 week-1 month, 1-3 months, 3-6 months and 6 months-1 yr after treatment periods.The operation time, the number of puncture, and development and recurrence of complications during treatment and within 1 yr after treatment were recorded.Results Compared with CT group, the number of puncture and incidence of facial hematoma during treatment were significantly increased（P〈0.05 or 0.01）, and no significant change was found in the operation time, requirement for oxcarbazepine and adjuncts, incidence of dizziness, nausea and vomiting during treatment, or the incidence and recurrence rate of masticatory muscle weakness and facial numbness after treatment in X-ray group（P〉0.05）.Conclusion Compared with the three dimensional CT, X-ray provides similar efficacy and safety when used to guide adriamycin injection via the foramen ovale and around peripheral trigeminal branches for treatment of primary trigeminal neuralgia, showing that X-ray guidance has significant clinical value.

关 键 词：体层摄影术 X线计算机 成像 王维 阿霉素 三叉神经痛 

分 类 号：R745.11[医药卫生—神经病学与精神病学]