CT引导下茎突后双针双极射频热凝术治疗舌咽神经痛的疗效观察  

The observation of CT guided bipolar radiofrequency thermocoagulation behind styloid process in the treatment of patients with glossopharyngeal neuralgia

作　　者：黄冰 吴丹 杜鑫丹 林慧丹 占恭豪[5] 姚明[1] Huang Bing;Wu Dan;Du Xindan;Lin Huidan;Zhan Gonghao;Yao Ming(Department of Pain Medicine,the Affiliated Hospital of Jiaxing University,Jiaxing City,Zhejiang Province 314000,China;Department of Pain Medicine,the Central Hospital of Lishui,Lishui City,Zhejiang Province 323000,China;Department of Pain Medicine,the Redcross Hospital of Hangzhou,Hangzhou City,Zhejiang Province 310006,China;Department of Pain Medicine,the First Hospital of Ningbo,Ningbo City,Zhejiang Province 315000,China;Department of Pain Medicine,the Affiliated Hospital of Wenzhou Medical University,Wenzhou City,Zhejiang Province 325000,China)

机构地区：[1]嘉兴学院附属医院疼痛科,浙江省嘉兴市314000 [2]丽水中心医院疼痛科,浙江省丽水市323000 [3]杭州市红会医院疼痛科,杭州市310006 [4]宁波市第一医院疼痛科,宁波市315000 [5]温州医科大学附属第二医院疼痛科,温州市325000

出　　处：《中华疼痛学杂志》2021年第2期178-185,共8页Chinese Journal Of Painology

基　　金：浙江省医药卫生平台重点项目(2016ZDA018);浙江省社会公益类研发项目(LGF20H090021)。

摘　　要：目的对比观察CT引导下茎突后双针双极与单针射频热凝术治疗舌咽神经痛的临床疗效。方法收集2016年8月至2019年12月于嘉兴学院附属医院疼痛科、丽水中心医院疼痛科、杭州市红会医院疼痛科、宁波市第一医院疼痛科及温州医科大学附属第二医院疼痛科就诊的舌咽神经痛患者共19例,以抛硬币法随机分入单针单极射频治疗组即单针组(n=10)和双针双极射频治疗组即双针组(n=9)。全部患者均于CT引导下将射频穿刺针穿刺至术前设计的治疗靶点,单针组穿刺至患侧茎突中点后缘,双针组则用两根射频针分别穿刺至茎突中内、中外1/3交界处后缘。随后用50 Hz、2 Hz频率电流(0.5~1)mA进行测试,咽部有异感而无迷走神经、副神经受激惹征象时,给予90℃、180~300 s射频治疗。观察记录两组患者穿刺深度与角度、治疗操作时间和首次治疗的有效率,并观察术中、术后并发症发生情况及治疗后1、3、6、12个月时的治疗效果。结果所有患者均在CT引导下将射频针穿刺至靶点,两组患者穿刺深度、穿刺角度比较差异均无统计学意义(P均<0.05)。单针组治疗操作时间[65.5(58.5,114.7)]min较双针组治疗操作时间[55.9(43.6,84.3)]min长,差异有统计学意义(Z=1.88,P<0.05);首次治疗后单针组和双针双极射频组疗效优良率[50%(5/10例)]比[77.8%(7/9例)],差异有统计学意义(χ^(2)=14.14,P<0.05)。结论CT引导下茎突后双针双极射频治疗舌咽神经痛,效果优于单针单极射频治疗,双针双极射频能缩短操作时间,还能提高对舌咽神经痛射频治疗的有效率。Objective To observe the clinical effect of CT guided double-needle bipolar and single-needle radiofrequency thermocoagulation behind styloid process in the treatment of glossopharyngeal neuralgia.Methods Nineteen patients with glossopharyngeal neuralgia from the Department of Pain Medicine of the Affiliated Hospital of Jiaxing University,the Department of Pain Medicine of the Central Hospital of Lishui,the Department of Pain Medicine of Redcross Hospital of Hangzhou,the Department of Pain Medicine of the First Hospital of Ningbo,and the Department of Pain Medicine of the Affiliated Hospital of Wenzhou Medical University,from August 2016 to December 2019,were divided into single-needle monopolar radiofrequency group(n=10)and double-needle bipolar radiofrequency group(n=9)with coin toss randomly.Under the guidance of CT,all patients were punctured at pre-designed treatment targets:the patients were punctured to the posterior margin of the middle point of styloid process in the single-needle group,while the patients were punctured to the posterior margin of 1/3 junction of styloid process with two radio-frequency needles in the double-needle group,and then tested with 50 Hz and 2 Hz frequency current(0.5 to 1)mA.When there was abnormal sensation in the pharynx but no sign of vagus nerve and accessory nerve stimulation,the radio-frequency was performed with 90℃for 180 to 300 seconds.The depth and angle of puncture were observed and recorded.The operation time and the effective rate of the first-time for the treatment,the follow-up observation of intraoperative and postoperative complications and treatment effect at 1 month,3 months,6 months,12 months were also recorded.Results Radiofrequency needles were successfully punctured to the target point under CT guidance in all patients.There was no significant difference in puncture depth and puncture angle between the two groups(P<0.05).The operation time of single needle and double needle group was[65.5(58.5,114.7)vs.55.9(43.6,84.3)]minutes,with significant difference

关 键 词：舌咽神经痛 射频热凝术 茎突 CT引导下 

分 类 号：R745.13[医药卫生—神经病学与精神病学]