神经内镜与显微镜血管减压术治疗面肌痉挛的疗效分析  

Comparing the therapeutic effects between endoscopic and microscopic vascular decompression for the treatment of hemifacial spasm

作　　者：张协军[1] 黄国栋[1] 阳吉虎 刘玉飞[1] 陈凡帆 陈垒[1] Zhang Xiejun;Huang Guodong;Yang Jihu;Liu Yufei;Chen Fanfan;Chen Lei(Department of Neurosurgery,Shenzhen Second People′s Hospital,the First Affiliated Hospital of Shenzhen University,Shenzhen 518000,China)

机构地区：[1]深圳市第二人民医院(深圳大学第一附属医院)神经外科,518000

出　　处：《中华神经外科杂志》2022年第1期24-28,共5页Chinese Journal of Neurosurgery

摘　　要：目的初步探讨神经内镜与显微镜血管减压术治疗面肌痉挛的有效性和安全性。方法回顾性分析2015年1月至2019年12月深圳市第二人民医院神经外科收治的92例面肌痉挛患者的临床资料。根据手术方式分为神经内镜组(简称内镜组,n=38)和显微镜组(n=54)。根据术后面肌痉挛症状缓解情况评估手术疗效。定期随访面肌痉挛症状缓解情况、有无复发以及术后并发症情况。比较两组患者的基线资料、手术疗效、术后并发症及随访结果。结果92例患者中,术中发现单支动脉压迫者88例,其中小脑前下动脉压迫73例,小脑后下动脉压迫13例,椎动脉压迫2例;小脑前下动脉合并小脑后下动脉压迫2例,小脑前下动脉合并小脑绒球压迫2例。术后症状完全缓解87例(94.6%),明显缓解5例(5.4%)。术后出现脑脊液鼻漏3例、听力丧失1例、听力减退4例、轻度面瘫2例。92例患者术后随访时间的中位数(四分位数间距)为30.0(18.8)个月。至末次随访,90例患者症状完全缓解,2例显微镜组患者症状复发。内镜组与显微镜组的年龄、性别、病程、责任血管和组织的差异均无统计学意义(均P>0.05)。两组比较,术后疗效、术后并发症、随访时间、末次随访时疗效的差异均无统计学意义(均P>0.05)。结论初步观察发现,神经内镜与显微镜血管减压术治疗面肌痉挛的有效性和安全性均较好,且未观察到两种术式的有效性和安全性存在差异。Objective To investigate the efficacy and safety of endoscopic and microscopic vascular decompression for the treatment of hemifacial spasm(HFS).Methods A retrospective analysis was conducted on the clinical data of 92 patients with HFS admitted to the Department of Neurosurgery,Shenzhen Second People′s Hospital from January 2015 to December 2019.All patients were divided into the neuroendoscopic group(n=38)and the microscopic group(n=54).The efficacy of surgery was evaluated based on the relief of HFS symptoms post operation.HFS symptom remission,recurrence and postoperative complications were followed up regularly.The baseline data,surgical efficacy,postoperative complications and follow-up results were compared between the two groups.Results Among the 92 patients,88 were intraoperatively identified to have compression caused by a single artery:anterior inferior cerebellar artery(AICA)in 73 cases,posterior inferior cerebellar artery(PICA)in 13 cases and vertebral artery(VA)in 2 cases.Among the remaining 4 patients,2 cases had multi-vessel(AICA and PICA)compression and the other 2 cases had compression caused by AICA and cerebellar pompons.Postoperative symptoms were completely relieved in 87 cases(94.6%)and significantly improved in 5 cases(5.4%).Postoperative cerebrospinal fluid rhinorrhea occurred in 3 cases,hearing loss in 1 case,hearing decline in 4 cases,and mild facial paralysis in 2 cases.The median(interquartile range)postoperative follow-up time of 92 patients was 30.0(18.8)months.At the end of follow-up,90 patients showed complete remission of symptoms,and 2 patients in the microscopic group relapsed.There were no significant differences in age,gender,course of disease or offending vessels and tissues between the two groups(all P>0.05).There were no significant differences in postoperative efficacy,postoperative complications,follow-up time,efficacy at the last follow-up between the two groups(all P>0.05).Conclusion Preliminary observation has shown that both endoscopic and microscopic vascular are

关 键 词：面部单侧痉挛 减压术 外科 自然腔道内镜手术 显微外科手术 治疗结果 

分 类 号：R651.3[医药卫生—外科学]