显微血管减压术与射频热凝术治疗原发性三叉神经痛的疗效分析  

Effect Analysis of Microvascular Decompression and Radiofrequency Thermocoagulation in the Treatment of Primary Trigeminal Neuralgia

作　　者：蔡佳宏[1] 邹叔骋[2] 李凌[2] CAI Jiahong;ZOU Shucheng;LI Ling(Hunan University of Chinses Medicine,Changsha 410000,China)

机构地区：[1]湖南中医药大学,湖南长沙410000 [2]湖南省脑科医院

出　　处：《中国医学创新》2020年第6期25-29,共5页Medical Innovation of China

基　　金：湖南省技术创新引导项目(2018SK50605)。

摘　　要：目的:探究显微血管减压术(MVD)与射频热凝术(RT)治疗原发性三叉神经痛的效果、并发症及复发情况。方法:回顾性分析2015年5月-2017年5月本院手术治疗的113例原发性三叉神经痛患者的临床资料,其中行显微血管减压术治疗60例(MVD组),行射频热凝术治疗53例(RT组),术前、术后采用Barrow神经病学研究所(BNI)三叉神经痛分级评价、卡氏功能状态评分表(KPS)评价其疼痛缓解及生活质量,对两组疗效、并发症及复发情况进行分析。结果:随访中,MVD组6例(10.00%)出现术后并发症,患侧面部轻度麻木感5例(8.33%)、口角疱疹1例(1.67%);RT组6例(11.32%)出现术后并发症,患侧面部轻度麻木感6例(11.32%)。随访中,MVD组52例(86.67%)疼痛完全缓解(BNI分级Ⅰ级),7例(11.67%)疼痛部分缓解(BNI分级Ⅱ~Ⅲ级),1例(1.67%)疼痛无缓解(BNI分级Ⅳ~Ⅴ级),复发3例(5.00%),术前KPS评分为(65.83±13.94)分,术后KPS评分为(89.67±12.35)分,患者生活质量得到了显著改善(P<0.05);随访中,RT组14例(26.42%)疼痛完全缓解,39例(73.58%)疼痛部分缓解,复发6例(11.32%),术前KPS评分为(61.51±16.22)分,术后KPS评分为(73.96±16.33)分,患者生活质量得到了显著改善(P<0.05)。术后MVD组疼痛缓解、生活质量改善程度均优于RT组(P<0.05)。结论:MVD和RT治疗原发性三叉神经痛均安全、有效,均能显著减轻患者的疼痛和提高生活质量,可首选MVD,对有明显手术禁忌证、患有其他基础疾病不能耐受减压术者则可选择RT。Objective:To explore the efficacy,complications and recurrence of microvascular decompression (MVD) and radiofrequency thermocoagulation (RT) in the treatment of primary trigeminal neuralgia.Method:A retrospective analysis was made to the clinical data of 113 cases with primary trigeminal neuralgia undergoing surgery.60 patients were treated with MVD (MVD group) and 53 patients were treated with RT (RT group).Barrow Neurological Institute (BNI) grade and Karnofsky Performance Status (KPS) score were used to evaluate the pain relief and the quality of life,the efficacy,complications and recurrence of two groups were analyzed.Result:MVD group,6 cases (10.00%) presented with postoperative complications,included 5 cases (8.33%) of facial numbness of operation side,1 case (1.67%) of herpes.RT group,6 cases (11.32%) presented with postoperative complications,included 5 cases (8.33%) of facial numbness of operation side.During the follow-up,MVD group,52 cases (86.67%) had complete pain relief (BNI grade Ⅰ),7 cases (11.67%) had partial pain relief (BNI grade Ⅱ-Ⅲ),1 case (1.67%) had no pain relief (BNI grade Ⅳ-Ⅴ),3 cases (5.00%) recurred after MVD,preoperative and postoperative KPS scores were (65.83±13.94) and (89.67±12.35) scores,patients’ quality of life had improved significantly (P<0.05).14 cases (26.42%) had complete pain relief,39 cases (73.58%) had partial pain relief,6 cases (11.32%) recurred after RT,preoperative and postoperative KPS scores were (61.51±16.22) and (73.96±16.33) scores,patients’ quality of life had improved significantly (P<0.05).The degree of pain relief and quality of life improvement in MVD group were higher than those in RT group after surgey (P<0.05).Conclusion:MVD and RT in the treatment of primary trigeminal neuralgia are safe and effective,which can significantly relief the pain of patients and improve the quality of life.MVD should be the first choice for patients,and RT should be the choice for those with significant surgical contraindications and other underlying dise

关 键 词：原发性三叉神经痛 显微血管减压术 射频热凝术 

分 类 号：R651.3[医药卫生—外科学]