原发性三叉神经痛经皮半月神经节射频热凝术后复发的危险因素  

Risk factors for postoperative recurrence of patients with primary trigeminal neuralgia after percutaneous trigeminal radiofrequency thermocoagulation

作　　者：李雷 张来健 徐宏志 韩露 LI Lei;ZHANG Lai-jian;XU Hong-zhi;HAN Lu(Department of Neurosurgery,Lianyungang Hospital,Xuzhou Medical University,Lianyungang 222061,China)

机构地区：[1]徐州医科大学附属连云港医院神经外科,江苏连云港222061

出　　处：《中国临床神经外科杂志》2021年第10期776-779,共4页Chinese Journal of Clinical Neurosurgery

基　　金：江苏省卫生计生委课题(H201891)。

摘　　要：目的探讨原发性三叉神经痛(PTN)经皮半月神经节射频热凝术(PRT)治疗后复发的影响因素。方法回顾性分析2013年6月至2019年12月PRT治疗的438例PTN的临床资料。术后随访12~84个月,中位随访时间49个月。术后3个月以后再次出现三叉神经痛症状判定为复发。结果438例中,术后复发35例,复发率为8.0%。多因素logistic回归分析显示,非典型疼痛、病程≥48个月、既往微血管减压术或伽玛刀治疗史及术前BNI分级Ⅴ级为PTN病人PRT后复发的独立危险因素(P<0.05)。根据4个独立危险因素的比值比进行赋分,总分0~10分,其中0~5分为低风险组,6~10分为高风险组。低风险组PRT后复发率0fen[3.30%(7/212)]明显低于高风险组[12.39%(28/226);P<0.001]。ROC曲线分析结果显示,预警评分系统预测PTN病人PRT后复发的曲线下面积为0.729(95%置信区间0.701~0.913),最佳截断值为6.0分;评分≥6.0分预测术后复发的敏感度为0.939,特异度为0.601,Youden指数为0.540。结论对PTN病人,如果疼痛不典型、病程长、既往有手术治疗史及术前BNI分级高,PRT后复发风险高,注意密切随访。基于4个危险因素建立的评分系统对预测病人术后复发有一定的价值,有助于临床进行风险评估。Objective To investigate the risk factors for postoperative recurrence of the patients with primary trigeminal neuralgia(PTN)after the percutaneous trigeminal radiofrequency thermocoagulation(PRT).Methods A retrospective analysis was performed on the clinical data of 468 PTN patients who underwent PRT from June 2013 to December 2019.The postoperative follow-up time ranged from 12 months to 84 months,with a medium time of 49 months.A recurrence was defined as:the trigeminal neuralgia symptoms recurred 3 months after the operation.Results Of 438 PTN patients,35 patients had a recurrence,with a recurrence rate of 8.0%.Multivariate logistic regression analysis showed that atypical pain,course of disease≥48 months,previous history of microvascular decompression or gamma knife treatment and preoperative BNI grade V were independent risk factors for the recurrence of PTN after PRT(P<0.05).The scores were assigned according to the odds ratios of these 4 independent risk factors,with a total score of 0~10 points,of which 0~5 were low-risk and 6~10 were high-risk.The recurrence rate of low-risk group[3.30%(7/212)]was significantly lower than that[12.39%(28/226)]of high-risk group(P<0.001).ROC curve analysis results showed that the area under the curve for the scoring system to predict the recurrence of PTN after PRT was 0.729(95%CI 0.701~0.913)and the best cut-off value was 6.0 points;the sensitivity and specificity of score≥6.0 points to predict the postoperative recurrence was 0.939 and 0.601,respectively;the Youden index was 0.540.Conclusions Close follow-up should be recommended for the PTN patients whose pain is atypical,disease course is long,surgical treatment history is true and preoperative BNI grade is high,because they have high risk of recurrence after PRT.The scoring system established based on 4 risk factors has certain value in predicting postoperative recurrence of PTN patients,and is helpful for clinical risk assessment.

关 键 词：原发性三叉神经痛 经皮半月神经节射频热凝术 术后复发 危险因素 

分 类 号：R745.11[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]