面肌痉挛微血管减压术中困难减压的处理措施及其疗效分析  

Strategies of complex condition in microvascular decompression for hemifacial spasm

作　　者：邢亚洲[1] 王新军[2] 梁庆华[1] 

机构地区：[1]河南省人民医院郑州大学人民医院神经外科,郑州450003 [2]郑州大学第五附属医院神经外科,郑州450052

出　　处：《中华神经医学杂志》2017年第8期831-835,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨面肌痉挛微血管减压术中困难减压的疗效及其影响因素。方法回顾性收集河南省人民医院神经外科自2012年10月至2015年12月采用微血管减压术治疗的458例面肌痉挛患者的临床资料及随访结果，并依据是否有后颅窝狭小、压迫面神经的椎动脉延长扩张或合并较多穿支、责任血管穿行于颅神经之间等情况，将患者分为困难减压组（n=50）和一般减压组（n=408）。采用统计学方法分析这2组患者有效率及延迟缓解率的差异以及影响患者疗效、延迟缓解的相关因素。结果所有患者随访1～3年，平均（1．6±0．6）年。困难减压组有效率为92％（46／50），一般减压组有效率为95．6％（390／408），差异无统计学意义（x^2=0．592，P=0．442）。困难减压组延迟缓解率为47．8％（22／46），一般减压组延迟缓解率为25．1％（98／390），差异有统计学意义（x^2=10．627，P=-0．001）。二分类非条件Logistic回归分析显示面神经压痕为延迟缓解的危险因素（OR=7．681，P=0．004，95％CI：10．235-31．223）。结论对于困难减压的面肌痉挛患者，如果处理得当，其疗效与一般减压相当，但术后延迟缓解率可能较高。Objective To explore the efficacy of difficult decompression and its influence factors in microvascular decompression for hemifacial spasm. Methods A retrospective analysis of clinical data and follow-up results of 458 patients who underwent mierovaseular decompression for hemifacial spasm in our hospital from October 2012 to December 2015 was performed. According to whether there was narrow posterior fossa, compression of vertebral artery with perforating branch of brain stem or long vertebral artery, or vessel passing through cranial nerves, all patients were divided into difficult and general decompression groups （n=50, n=408）; the effective rate, delayed remission rate and their influencing factors were compared between the two groups. Results All patients were followed up for one to 3 years, averaging 1.6＋0.6 years. Among them, 46 patients from difficult decompression group were effective （effective rate=92% [46/50]）; and 390 patients from general decompression group were effective （effective rate=95.6% [390/408]）; no statistical difference was noted between the two groups （x^2=0.592, P=0.442）. But there was statistical difference in delayed remission rate between the two groups （47.8% vs. 25.1%, x^2=10.627,P=0.001）. Logistic regression analysis was performed among gender, age, course of disease, offending vessels, location, indentation of facial nerve, complex condition of microvacular decompression, efficacy rate and delayed relief rate, and it showed that indentation of facial nerve was related to delayed relief（OR=7.681, P=-0.004, 95%CI： 10.235-31.223）. Conclusion The hemifacial spasm patients with difficult decompression are able to achieve as good effect as general decompression if measures are used properly, but the delayed relief rate might be high.

关 键 词：面肌痉挛 微血管减压术 困难减压 

分 类 号：R651.3[医药卫生—外科学]