经皮穿刺微球囊压迫术治疗三叉神经痛术中监测囊内压力的初步探讨  

A preliminary study on the intra-balloon pressure monitoring during percutaneous balloon compression in the treatment of trigeminal neuralgia

作　　者：闫先侠 张三鹏 权俊杰[1] 张熙[1] 任鹏宇[1] 屈建强[1] 周乐[1] YAN Xianxia;ZHANG Sanpeng;QUAN Junjie;ZHANG Xi;REN Pengyu;QU Jianqiang;ZHOU Le(Department of Neurosurgery,Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;Department of Anesthesia and Surgery,Second Affiliated Hospital of Xi’an Jiaotong University)

机构地区：[1]西安交通大学第二附属医院神经外科,西安710004 [2]西安交通大学第二附属医院麻醉手术科

出　　处：《山西医科大学学报》2020年第6期588-592,共5页Journal of Shanxi Medical University

基　　金：国家自然科学基金青年基金资助项目(81801121);陕西省资源主导型产业关键技术(链)资助项目(2016KTCL03-08);陕西省重点研发计划项目(2017SF-026)。

摘　　要：目的探讨在经皮穿刺微球囊压迫术(PBC)中进行囊内压力监测以减少手术对个人经验依赖的可行性。方法选择2019年12月入住我院拟接受PBC手术的原发性三叉神经痛患者11例。术中将测压计与球囊导管连通,当球囊形状扩张到术者满意的"梨形"形状时,开始记录囊内压力,持续压迫并记录满3 min后,释放球囊压力并撤出球囊导管。所有手术操作均由同一位医师完成,囊内压力的监测由同一助手完成并对术者施盲。于术后第一天评估患者的疼痛缓解程度以及面部麻木和咀嚼肌无力症状,出院后定期随访。结果 11例球囊扩张到满意"梨形"形状时的压力(初压)为(123.5±13.0) kPa(99.8-140.2 kPa),持续压迫满3 min后,压力(末压)逐渐降至(107.3±12.6) kPa(89.9-125.4 kPa),初末压差(16.2±4.7)kPa(5.8-20.8 kPa)。除外1例疼痛控制不佳和2例麻木感难以耐受的患者,其余8位患者的初始压力在(125.4±10.4) kPa。术后3月随访,所有患者的疼痛症状均完全消失,麻木和咀嚼无力症状显著改善。结论 PBC术中,不同球囊在扩张到理想的"梨形"形状时产生的实际压力并不相同。在本研究的手术条件下,初始囊内压力控制在(125.4±10.4) kPa时,术后早期效果相对比较理想。术中监测球囊压力可为手术提供更加客观的指标,有利于减少该手术对个人经验的依赖。Objective To explore the feasibility of the intra-balloon pressure monitoring during percutaneous balloon compression(PBC)for reducing the dependence on personal operation experience.Methods Eleven consecutive patients with trigeminal neuralgia admitted to our hospital for PBC operation in December 2019 were selected.The pressure measuring device was connected to the balloon catheter,and the intra-balloon pressure was recorded once the shape of the balloon reached a desired“pear shape”to the opera-tor.After continuous compression and monitoring for 3 min,the balloon was released and pulled out.All PBC operations were performed by the same operator.All the intra-balloon pressure was monitored by the same assistant and blinded to the operator.Pain relief,facial numbness and masseter weakness were assessed on the first day after surgery and followed up regularly.Results The intra-balloon pressure(initial)was(123.5±13.0)kPa(99.8-140.2 kPa)when the balloons were initially expanded to the ideal“pear shape”.After continuous compression for 3 min,the pressure(final)gradually decreased to(107.3±12.6)kPa(89.9-125.4 kPa)without visible changes in the shape.The initial-final pressure difference was(16.2±4.7)kPa(5.8-20.8 kPa).Except for one patient with residual pain and two patients with intolerable numbness,the initial pressure of the remaining eight patients was(125.4±10.4)kPa.Three months after the operation,all the patients obtained completely pain relief,and the facial numbness and masseter weakness were significantly improved.Conclusion Even the classic pear-shaped balloon is obtained in all cases,the actual pressure in each balloon may be different.Under the reported operating conditions,keeping the initial intra-balloon pressure at(125.4±10.4)kPa may achieve better outcomes in early postoperative period.Monitoring the intra-balloon pressure during the PBC can provide a more objective indicator for the operation and help to reduce the dependence on personal experience.

关 键 词：经皮穿刺微球囊压迫术 三叉神经痛 囊内压力 

分 类 号：R651[医药卫生—外科学]