原发性三叉神经痛显微血管减压手术中责任病变的探查与分析  

Identification and analysis of offending lesions during the operation of microvascular decompression in primary trigeminal neuralgia

作　　者：齐猛[1] 刘洋[1] 蒋丽丹[1] 梁建涛[1] 

机构地区：[1]首都医科大学宣武医院,北京100053

出　　处：《山东医药》2017年第43期1-4,共4页Shandong Medical Journal

基　　金：北京市215高层次卫生技术人才学术骨干项目(2014-03-061)

摘　　要：目的探讨并总结原发性三叉神经痛的责任病变,提高手术治疗的针对性和准确性,以便对三叉神经进行充分减压。方法术前诊断为原发性三叉神经痛的患者91例,86例接受显微血管减压手术治疗,其中85例术中亦诊断为原发性三叉神经痛,根据术中探查所见,判断分析其三叉神经痛的责任病变。结果 85例原发性三叉神经痛患者术中发现单一责任血管者60例(70.6%,包括蛛网膜明显粘连3例),2支及以上责任血管者21例(24.7%),无责任血管者4例(4.7%,其中1例蛛网膜增厚粘连明显)。85例患者中,有蛛网膜增厚粘连者共4例(4.7%,其中3例合并动脉压迫、1例未见明显责任血管)。结论原发性三叉神经痛的责任病变除单一责任血管外,还包括2支及多支责任血管、合并蛛网膜明显粘连等,显微血管减压手术治疗中需要明确所有可能的责任病变,以便对三叉神经进行充分减压。Objective To explore and summarize the offending lesions of primary trigeminal neuralgia,in order to improve the pertinence and accuracy of surgery and achieve sufficient decompression of trigeminal nerve. Methods Ninetyone cases were diagnosed as primary trigeminal neuralgia before surgery,and 86 cases received planned microvascular decompression,of which 85 cases were verified as primary trigeminal neuralgia during surgery. According to surgical findings,the offending lesions of primary trigeminal neuralgia were identified and analyzed. Results Of the 85 cases with primary trigeminal neuralgia undergoing surgery,60 cases were found with only 1 offending vessel（ 70. 6%,including 3 cases with obvious arachnoid membrane adhesion）,21 cases with 2 or more offending vessels（ 24. 7%）,and 4 cases were found with no offending vessel（ 4. 7%,including 1 case with obvious arachnoid membrane adhesion）. Of all patients receiving surgery,4 cases（ 4. 7%） were found with arachnoid membrane adhesion,including 3 cases accompanied with artery compression and 1 case with no obvious offending vessel. Conclusions For primary trigeminal neuralgia,besides solely one vessel,the offending lesions include two or more vessels,obvious arachnoid membrane adhesion and others. During the operation of microvascular decompression,all possible offending lesions should be identified to achieve sufficient decompression of trigeminal nerve.

关 键 词：原发性三叉神经痛 责任病变 责任血管 动脉压迫 静脉压迫 蛛网膜粘连 

分 类 号：R651.1[医药卫生—外科学]