DSA引导下穿刺圆孔采用不同温度射频热凝治疗重度原发性三叉神经痛的临床研究  

Clinical study of radiofrequency thermocoagulation at different temperatures for severe primary trigeminal neuralgia using DSA-guided puncture via the foramen rotundum

作　　者：杨佳丽 刘诚 周鹏程 郭潇 陈沛 薛同庆 YANG Jiali;LIU Cheng;ZHOU Pengcheng;GUO Xiao;CHEN Pei;XUE Tongqing(Department of Pain and Interventional Vascular Surgery,Huai′an Huai′an Hospital,Huai′an,Jiangsu 223000,China)

机构地区：[1]淮安市淮安医院疼痛与介入血管外科,江苏淮安223000

出　　处：《徐州医科大学学报》2024年第9期692-697,共6页Journal of Xuzhou Medical University

基　　金：江苏省卫生健康委科研项目(Z2021045);淮安市自然科学研究计划项目(HAB202140)。

摘　　要：目的 探讨3D数字式减影血管成像(DSA)指引下不同温度射频热凝治疗重度原发性三叉神经痛(PTN)的临床疗效。方法 纳入2017年1月—2020年6月在淮安市淮安医院疼痛与介入血管外科进行治疗的57例累及上颌支的重度PTN患者作为研究对象,分为研究组30例、对照组27例;研究组采用90℃射频热凝治疗,对照组采用75℃射频热凝治疗。收集患者术前一般资料、随访信息,比较2组患者镇痛有效率及复发率。回归分析射频热凝术治疗PTN的术后复发的影响因素。结果 2组患者术后即刻疼痛缓解率分别为96.7%(研究组)、92.6%(对照组),差异无统计学意义(P>0.05);出院时2组疼痛缓解率均为100%。术后13个月开始出现复发病例,中位复发时间为20个月;其中研究组6例(20%)复发,中位复发时间为22个月,术后13个月、2年、3年复发率分别为0、13.3%、20%;对照组13例(48.1%)复发,中位复发时间为19个月,术后13个月、2年、3年复发率分别为7.4%、25.9%、48.1%,差异有统计学意义(P<0.05)。射频热凝温度是射频热凝术治疗PTN术后复发的影响因素(P<0.05)。研究组术后面部肿胀及面部感觉减退发生率高于对照组,但差异无统计学意义(P>0.05);2组患者均未发生复视、面瘫、脑出血及死亡等其他并发症。结论 采用90℃射频热凝治疗重度PTN安全有效,近期疗效与采用75℃射频热凝治疗相当,远期疗效优于采用75℃射频热凝治疗。Objective To explore the clinical effectiveness of radiofrequency thermocoagulation at different temperatures for severe primary trigeminal neuralgia guided by 3D digital subtraction angiography(DSA).Methods A total of 57 patients with severe primary trigeminal neuralgia involving the maxillary branch,who were treated at Department of Pain and Interventional Vascular Surgery,Huai′an Huai′an Hospital from January 2017 to June 2020,were included in the study.They were divided into two groups:a study group(n=30)and a control group(n=27).The study group underwent radiofrequency thermocoagulation at 90℃,while the control group was treated at 75℃.Their preoperative general data and follow-up information were collected.Both groups were compared for pain relief effectiveness and recurrence rates.Regression analysis was performed to investigate the factors influencing postoperative recurrence after radiofrequency thermocoagulation for primary trigeminal neuralgia.Results The immediate postoperative pain relief rates were 96.7%in the study group and 92.6%in the control group,without statistical differences(P>0.05).The pain relief rate at discharge was 100%in both groups.Recurrence began at postoperative 13 month,with a median recurrence time of 20 months.In the study group,6 patients(20%)experienced recurrence,with a median recurrence time of 22 months.The recurrence rates at postoperative 13 months,2 years,and 3 years were 0,13.3%,and 20%,respectively.In the control group,13 patients(48.1%)experienced recurrence,with a median recurrence time of 19 months.The postoperative recurrence rates at 13 months,2 years,and 3 years were 7.4%,25.9%,and 48.1%,respectively,with statistical differences between the two groups(P<0.05).The radiofrequency thermocoagulation temperature was identified as a factor influencing postoperative recurrence(P<0.05).The study group had a higher incidence of facial swelling and sensory reduction compared with the control group,without statistical differences(P>0.05).No cases of diplopia,facial

关 键 词：射频 温度 介入治疗 经皮穿刺 圆孔 三叉神经痛 

分 类 号：R745.11[医药卫生—神经病学与精神病学]