61例原发性药物难治性舌咽神经痛的临床特点及手术疗效分析  

Analysis of clinical characteristics and therapeutic efficacy of 61 cases of primary drug-refractory glossopharyngeal neuralgia

作　　者：王雷波[1] 李鹏存 董晓霞[1] 王均伟[1] 刘清军[1] Wang Leibo;Li Pengcun;Dong Xiaoxia;Wang Junwei;Liu Qingjun(Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350,China;Department of Neurosurgery,Feicheng People's Hospital,Feicheng 271699,China)

机构地区：[1]天津市环湖医院神经外科,天津300350 [2]山东省肥城市人民医院神经外科,肥城271699

出　　处：《中华神经外科杂志》2024年第4期367-371,共5页Chinese Journal of Neurosurgery

摘　　要：目的分析原发性药物难治性舌咽神经痛(CPN)的临床特点及不同手术方式的疗效。方法纳入2014年3月至2021年3月天津市环湖医院神经外科诊治的61例原发性药物难治性GPN患者进行回顾性分析。男/女为32/29;年龄为(67.7±25.4)岁(43~88岁);中位病程为44.1个月(7d至18年)。39例行显微血管减压术(MVD组);22例行神经根丝切断术(RHZ组),主要切断舌咽神经+迷走神经第1支。观察GPN的责任血管、手术疗效及相关并发症。结果61例患者,术中发现小脑后下动脉(PICA)为责任血管者的占比最高(63.9%,39例),无血管压迫者占3.3%(2例)。两组患者术后疼痛均即刻消失,有效率均为100%。术后MVD组有2例患者发生脑出血,其中1例死亡,1例遗留轻度神经功能缺损症状。RHZ组8例(36.4%)患者存在第Ⅸ、Ⅹ、Ⅺ对脑神经相关的功能障碍,其中5例为悬雍垂偏斜,3例为吞咽呛咳;MVD组1例(2.7%)有吞咽呛咳,两组比较差异有统计学意义(P=0.001)。61例患者术后随访(56.7±38.5)个月(12~96个月),MVD组1例(2.7%)患者术后46个月疼痛复发。悬雍垂偏斜的5例患者术后6个月均好转;4例吞咽呛咳的患者中,仅1例RHZ组患者偶尔有呛咳症状。结论MVD是治疗原发性药物难治性GPN的有效术式RHZ是MVD的有效补充术式,并发症发生率虽高,但大部分可恢复,无严重并发症发生。Objective To analyze the clinical characteristics of patients with primary drug-refractory glossopharyngeal neuralgia(GPN)and the efficacy of different surgical methods.Methods A total of 61 patients with drug-refractory GPN diagnosed and treated at the Neurosurgery Department of Tianjin Huanhu Hospital from March 2014 to March 2021 were included for retrospective analysis.The male/female ratio was 32/29;the age was(67.7±25.4)years old(43-88 years old);the median disease duration was 44.1 months(7 days to 18 years).Microvascular decompression(MVD)was performed in 39 cases;rhizotomy(RHZ)was performed in 22 cases to cut off the glossopharyngeal nerve and the first branch of the vagus nerve.We documented the offending blood vessels of GPN,surgical efficacy and related complications.Results Among the 61 patients,most patients(63.9%,n=39)had the posterior inferior cerebellar artery(PICA)as the offending blood vessel identified during surgery,and 2 patients(3.3%)had no vascular compression.The pain of both groups of patients disappeared immediately after surgery,and the effective rate was 100%.After surgery,2 patients in the MVD group developed cerebral hemorrhage,1 died,and 1 remained with symptoms of mild neurological deficit.Eight cases(36.4%)in the RHZ group had dysfunction related to cranial nerves Ⅸ,Ⅹ and Ⅺ,of which 5 cases were uvula deviation and 3 cases were coughing during swallowing;1 patient in MVD group(2.7%)had coughing during swallowing;the difference between the two groups was statistically significant(P=0.001).All 61 patients were followed up for(56.7±38.5)months(12 to 96 months)after surgery,and 1 patient(2.7%)in the MVD group had recurrence of pain 46 months after surgery.The 5 patients with uvula deviation all improved 6 months after surgery;among the 4 patients with choking and coughing when swallowing,only 1 patient in the RHZ group occasionally had symptoms of choking and coughing.Conclusions MVD is an effective surgical procedure for the treatment of primary GPH.RHZ is an effective compl

关 键 词：舌咽神经疾病 疾病特征 治疗结果 显微血管减压术 神经根丝切断术 

分 类 号：R651.3[医药卫生—外科学]