伽玛刀治疗伴或不伴微血管压迫原发性三叉神经痛的效果观察  

Effect of Gamma Knife on Primary Trigeminal Neuralgia Associated by Microvascular Compression

作　　者：刘艳宁 郭洪均 乔民 张卫宁[1] 曾维俊 张立钊 张月爽 LIU Yan-ning;GUO Hong-jun;QIAO Min;ZHANG Wei-ning;ZENG Wei-jun;ZHANG Li-zhao;ZHANG Yue-shuang(Department of Neurosurgery,980 Hospital of PLA Joint Logistics Support Forces,Shijiazhuang 050082,China;Gamma Knife Center,980 Hospital of PLA Joint Logistics Support Forces,Shijiazhuang 050082,China)

机构地区：[1]中国人民解放军联勤保障部队第九八〇(白求恩国际和平)伽玛刀中心,石家庄050082 [2]中国人民解放军联勤保障部队第九八〇(白求恩国际和平)医院神经外科,石家庄050082

出　　处：《临床误诊误治》2020年第11期100-104,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省卫计委医学科学研究指导课题(20130329)。

摘　　要：目的观察伽玛刀治疗伴或不伴微血管压迫原发性三叉神经痛(primary trigeminal neuralgia,PTN)的效果。方法选取PTN 158例作为研究对象,根据MRI检查结果将其分为伴微血管压迫的观察组(83例)和不伴微血管压迫的对照组(75例)。两组均行伽马刀治疗。观察比较两组治疗前和治疗后12个月疼痛程度和血清β-内啡肽、P物质(SP)水平,治疗后12个月疼痛治愈率、疼痛治疗有效率、血清β-内啡肽升高率、血清SP下降率,以及治疗后并发症发生率。结果治疗前及治疗后12个月,两组视觉模拟评分法(VAS)评分比较差异均无统计学意义(P>0.05)。治疗后12个月,两组VAS评分均较治疗前降低,差异有统计学意义(P<0.05)。治疗前及治疗后12个月,两组血清β-内啡肽和SP水平比较差异均无统计学意义(P>0.05)。治疗后12个月,两组血清β-内啡肽水平均较治疗前升高,血清SP水平均较治疗前降低,差异均有统计学意义(P<0.05或P<0.01)。治疗后12个月,两组疼痛治愈率、疼痛治疗有效率及血清β-内啡肽升高率、血清SP下降率比较差异均无统计学意义(P>0.05)。治疗后,观察组并发症发生率为10.8%,对照组并发症发生率为9.3%,两组比较差异无统计学意义(P>0.05)。结论伽玛刀治疗伴或不伴微血管压迫PTN均效果满意,并发症少。Objective To observe the effect of Gamma knife on primary Trigeminal Neuralgia(PTN)in patients with microvascular compression and those without microvascular compression.Methods A total of 158 patients with PTN were selected as study subjects,and were divided into observation group(with microvascular compression,n=83)and control group(without microvascular compression,n=75)according to MRI results.Both groups received Gamma knife treatment.Pain,serumβ-endorphins,and substance P(SP)levels were compared between the two groups before and at 12 months after treatment.The pain cure rate,the effective rate of pain treatment,the increased rate of serumβ-endorphin,the decreased rate of serum SP,and the incidence of complications were also compared between the two groups at 12 months after treatment.Results There was no significant difference in visual analogue scale(VAS)scores between the two groups before and at 12 months after treatment(P>0.05).At 12 months after treatment,VAS scores in both groups were lower than those before treatment(P<0.05).There was no significant difference in serumβ-endorphin and SP levels between the two groups before and at 12 months after treatment(P>0.05).At 12 months after treatment,serumβ-endorphin levels in both groups were higher than those before treatment,and serum SP levels were lower than those before treatment(P<0.05 or P<0.01).At 12 months after treatment,there were no statistically significant differences in pain cure rate,effective rate of pain treatment,serum increase rate ofβ-endorphin and decreased rate of serum SP between the two groups(P>0.05).The complication rate was 10.8%in the observation group and 9.3%in the control group after treatment,and there was no statistically significant difference between the two groups(P>0.05).Conclusion Gamma knife was effective in the treatment of PTN with or without microvascular compression,with fewer complications.

关 键 词：三叉神经痛 微血管压迫 伽玛刀 Β-内啡肽 P物质 

分 类 号：R745.11[医药卫生—神经病学与精神病学]