脑神经疾病显微血管减压术中困难减压的处理及疗效  

Management of Difficult Decompression During Microvascular Decompression of Cranial Nerve Diseases and Its Efficacy

作　　者：张锋 司凯闯 郑鲁 赵中甫 ZHANG Feng;SI Kaichuang;ZHENG Lu;ZHAO Zhongfu(Department of Neurosurgery,Xuchang Central Hospital,Xuchang 461000,China)

机构地区：[1]许昌市中心医院神经外科,河南许昌461000

出　　处：《河南医学研究》2023年第10期1800-1805,共6页Henan Medical Research

基　　金：许昌市科技计划项目(20190213216)。

摘　　要：目的 探讨显微血管减压术(MVD)治疗脑神经疾病术中出现困难减压的处理方法及其疗效。方法 搜集分析许昌市中心医院2015年1月至2022年1月423例接受MVD治疗的脑神经疾病患者的临床资料和随访结果。术中出现困难减压50例,常规减压373例。对于困难减压患者,综合采取包括减压材料塑形、过度换气缓慢释放脑脊液、经小脑水平裂-小脑脑桥裂入路解剖显露、悬吊法、架桥法等方法处理。结果 术后随访1~3 a,常规减压组中三叉神经痛患者术后治愈138例,有效20例,无效10例;3例舌咽神经痛患者均治愈;面肌痉挛患者术后即刻缓解114例,延迟缓解76例,部分缓解和无效者共12例;常规减压组中手术有效351例,手术无效22例。困难减压组中三叉神经痛患者术后治愈15例,有效4例,无效2例;面肌痉挛患者17例术后即刻缓解,10例延迟缓解,部分缓解和无效者共2例;困难减压组中手术有效46例,手术无效4例。常规减压组手术有效率为94.10%(351/373),困难减压组手术有效率为92.00%(46/50),二者差异无统计学意义(P>0.05)。常规减压组术后总并发症发生率9.4%(35/373),困难减压组术后总并发症发生率12.0%(6/50),二者差异无统计学意义(P>0.05)。两组均无严重并发症及死亡病例。结论 MVD治疗脑神经疾病术中出现困难减压并不是影响手术疗效的决定性因素,通过仔细的术前评估、灵活的困难减压应对策略,困难减压患者术后也可以取得很好的疗效。Objective To explore the treatment method and efficacy of difficult decompression during microvascular decompression(MVD)of cranial nerve diseases.Methods Clinical data and follow-up results of 423 patients treated with MVD from January 2015 to January 2022 were retrospectively reviewed.There were 50 cases of difficult intraoperative decompression and 373 cases of conventional decompression.For patients with difficulty in decompression,comprehensive methods including decompression material shaping,excessive ventilation and slow release of cerebrospinal fluid,anatomical exposure through transhorizontal-cerebellopontine fissure approach,suspension method and bridging method are properly adopted.Results After postoperative follow-up of 1 to 3 years,138 patients with trigeminal neuralgia were cured after surgery,20 were effective and 10 were ineffective.All three patients with glossopharyngeal neuralgia were cured.There were 114 patients with hemifacial spasm had immediate postoperative remission,76 cases delayed remission,and 12 cases of partial remission and ineffectiveness.A total of 351 cases were surgically effective and 22 cases were ineffective in the conventional decompression group.In the difficult decompression group,15 patients with trigeminal neuralgia were cured,4 cases were effective and 2 cases were ineffective.Patients with immediate postoperative remission of hemifacial spasm were 17,10 cases delayed remission,and 2 cases of partial remission and ineffectiveness.A total of 46 cases were surgically effective and 4 cases were ineffective in the difficult decompression group.The operative response rate was 94.10%(351/373)in the conventional decompression group,the operative response rate in the difficult decompression group was 92.00%(46/50),and there was no significant difference(P>0.05).The overall postoperative complication rate in the conventional decompression group was 9.4%(35/373),the overall postoperative complication rate in the difficult decompression group was 12.0%(6/50),and the difference w

关 键 词：脑神经疾病 显微血管减压术 困难减压 

分 类 号：R651[医药卫生—外科学]