伽玛刀二次治疗复发或无效的原发性三叉神经痛的疗效分析  

Analysis of therapeutic effect of secondary gamma knife for recurrent or ineffective primary trigeminal neuralgia

作　　者：王浩然 王宏伟[1] 窦长武[1] 段惠远[2] 鞠海涛[1] 牛瑞芳[1] 张国荣[1] 何占彪[1] 尹俊[1] Wang Haoran;Wang Hongwei;Dou Changwu;Duan Huiyuan;Ju Haitao;Niu Ruifang;Zhang Guorong;He Zhanbiao;Yin Jun(Head Gamma Knife Treatment Center, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China;Gamma Knife Treatment Center, Hainan General Hospital, Haikou 570311, China)

机构地区：[1]内蒙古医科大学附属医院头部伽玛刀治疗中心,呼和浩特010050 [2]海南省人民医院伽玛刀治疗中心,海口570311

出　　处：《中华神经外科杂志》2019年第3期264-268,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨伽玛刀二次治疗复发或无效的原发性三叉神经痛的有效性、安全性及影响因素。方法回顾性纳入2004年1月至2016年12月在内蒙古医科大学附属医院头部伽玛刀治疗中心接受伽玛刀二次治疗的28例原发性三叉神经痛(PTN)患者,占同期伽玛刀治疗原发性三叉神经痛的4.6%(28/604)。包括19例首次治疗后复发、9例首次治疗后无效选择伽玛刀二次治疗的患者。采用巴罗神经学研究所(BNI)的分级评定标准评价治疗后疼痛的缓解程度。分析年龄(<70岁,≥70岁)、病程(≤5年,>5年)、两次治疗的时间间隔(≤20个月,>20个月)、首次伽玛刀治疗的疗效(复发,无效)以及累积照射剂量(130~145 Gy,165~190 Gy)对伽玛刀二次治疗后疼痛完全缓解及并发症的影响。结果28例PTN患者二次伽玛刀治疗的中位疼痛缓解时间为3.0(1.0~4.8)个月,有效缓解率为96.4%(27/28),并发症发生率为32.1%(9/28),复发率为3.6%(1/28)。单因素分析结果显示,累积照射剂量是伽玛刀二次治疗后疼痛完全缓解的影响因素(P=0.028);两次治疗的时间间隔、首次治疗的疗效是二次治疗后并发症发生的影响因素(均P<0.05)。多因素分析结果显示,两次治疗的时间间隔≤20个月(OR=0.010,95%CI:0.001~0.195,P=0.002)是伽玛刀二次治疗并发症发生的独立危险因素。结论伽玛刀二次治疗PTN的疗效同样值得肯定。双靶点、低累积剂量照射会使PTN患者更易获得有效缓解,伽玛刀二次治疗在首次治疗后1.5年或2.0年以上,并发症发生的可能性会明显减少。Objective To evaluate the effectiveness, safety and influencing factors of Gamma Knife radiosurgery (GKRS) for retreatment of primary trigeminal neuralgia (PTN). Methods A retrospective analysis was conducted on 28 patients with primary trigeminal neuralgia who underwent secondary GKRS at Head Gamma Knife Treatment Center of the Affiliated Hospital of Inner Mongolia Medical University from January 2004 to December 2016. Pain relief was assessed by the Barrow Neurological Institute(BNI). Analysis was conducted on possible predictive factors including age (<70,≥70 years), course of disease (≤5,>5years), intervals between two treatments (≤20,>20 months), outcome of the first treatment (recurrent, ineffective), cumulative radiation dose (130-145 Gy, 165-190 Gy) to complete pain relief and complications after the second GKRS. Results The median time for pain relief in secondary treatment was 3.0(1.0-4.8) months. The pain relief rate was 96.4%(27/28) and complications occurred in 32.1%(9/28) of the cases. The relapse rate was 3.6%(1/28). Univariate analysis revealed significant differences in cumulative exposure doses for complete remission (P=0.028). Intervals of the two treatments and outcome of the first treatment were closely related to the complications of the secondary GKRS (both P<0.05). Multivariate analysis showed that the interval between two treatments not more than 20 months was an independent risk factor for complications of secondary treatment (OR=0.010, 95%CI: 0.001-0.195, P=0.002). Conclusions The efficacy of retreatment of PTN is also worthy of recognition. Dual targets, low cumulative doses irradiating PTN will make it easier for patients to achieve complete remission. If the interval time is more than 1.5 or 2.0 years after the first GKRS, the possibility of complications would be significantly reduced.

关 键 词：三叉神经痛 放射外科手术 复发 影响因素分析 

分 类 号：R745.11[医药卫生—神经病学与精神病学]