CT联合超声引导经圆孔上颌神经射频热凝术治疗V2三叉神经痛  

CT combined with ultrasound-guided radiofrequency thermocoagulation of maxillary nerve through foramen rotundum for treatment of V2 trigeminal neuralgia

作　　者：王然[1] 朱彤[1] 王玉 韩影[1] WANG Ran;ZHU Tong;WANG Yu;HAN Ying(Department of Pain Management,Nanjing Drum Tower Hospital the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Anesthesiology,Xinghua People's Hospital,Taizhou 225700,China)

机构地区：[1]南京大学医学院附属鼓楼医院疼痛科,南京210008 [2]兴化市人民医院麻醉科,泰州225700

出　　处：《中国疼痛医学杂志》2023年第7期507-513,共7页Chinese Journal of Pain Medicine

基　　金：国家自然科学基金青年科学基金(81801100)。

摘　　要：目的:探讨CT联合超声引导经圆孔上颌神经射频热凝术在V2支三叉神经痛(trigeminal neuralgia,TN)中的应用,并与CT引导对照,评价该技术方案的精准性、有效性和安全性。方法:回顾性分析南京鼓楼医院疼痛科2017年1月至2021年3月收治并经圆孔行上颌神经射频热凝术治疗的V2支TN病人60例,根据引导方式不同分为CT组(n=41)和CT联合超声组(n=19)。记录两组穿刺次数、扫描次数、辐射剂量、穿刺时间、手术时间、并发症发生率。观察术前、术后2周、4周、12周、24周疼痛数字分级评分法(numerical rating scale,NRS)评分、巴罗神经学研究所(Barrow neurological institute,BNI)评分,计算术后疼痛良好缓解率(BNI:Class I级或II级)。结果:与CT组相比,CT联合超声组穿刺次数和扫描次数更少,辐射暴露更低,穿刺时间和手术时间更短(P<0.05);与术前相比,两组病人在术后各随访时间点NRS评分均明显改善(P<0.05);术后各时间点疼痛良好缓解率组间差异无统计学意义;两组面部血肿发生率差异无统计学意义,均无其他严重并发症。结论:CT联合超声引导下经圆孔上颌神经射频热凝术是治疗V2支TN的可行方案,相比CT引导,该方案可以明显提升穿刺精准性并降低治疗相关的辐射暴露。Objective:To study the application of CT combined with ultrasound-guided radiofrequency thermocoagulation of maxillary nerve through foramen rotundum for treatment of V2 trigeminal neuralgia(TN),and to observe the accuracy,effectiveness and safety of this technique by comparing with CT-guided method.Methods:Total of 60 patients with V2 branch TN admitted to Pain Management Department of Nanjing Drum Tower Hospital and maxillary nerve treated with radiofrequency thermocoagulation of maxillary nerve through foramen rotundum were reviewed and divided into CT group(n=41)and CT combined with ultrasound group(n=19)according to the guidance methods.The numbers of puncture and scan,the radiation dose,the puncture time,the operation time,and the incidence of treatment complications were recorded and compared between groups.Numerical rating scale(NRS)scores and Barrow neurological institute(BNI)scores were observed before surgery,2 weeks,4 weeks,12 weeks and 24 weeks after surgery.The rate of good pain relief after surgery(BNI:Class I or II)was calculated.Results:Compared with the CT group,the CT combined with ultrasound group had fewer puncture and scan times,lower radiation exposure,and shorter puncture and surgical time(P<0.05).After surgery,NRS scores in both groups were significantly improved at each follow-up time point(P<0.05).There was no significant difference in the rate of good pain relief at each time point between the two groups.There was no significant difference in the incidence of facial hematoma between the two groups.No other serious complications occurred in both groups.Conclusion:CT combined with ultrasound-guided radiofrequency thermocoagulation of maxillary nerve through foramen rotundum is a feasible method for the treatment of V2 branch TN.Compared with CT guidance,this method can significantly improve puncture accuracy and reduce radiation exposure related to treatment.

关 键 词：上颌神经 超声 圆孔 三叉神经痛 射频热凝术 

分 类 号：R745.11[医药卫生—神经病学与精神病学]