血管压迫类型与原发性三叉神经痛经皮球囊压迫术疗效关系的研究  

Study on the relationship between vascular compression types and the efficacy of transcutaneous balloon compression for primary trigeminal neuralgia

作　　者：种玉龙 王晶[1] 姜成荣 朱春然[2] 徐武[1] 李岩 梁维邦[1] Chong Yulong;Wang Jing;Jiang Chengrong;Zhu Chunran;Xu Wu;Li Yan;Liang Weibang(Department of Neurosurgery,Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School,Nanjing 210008,China;Department of Neurosurgery,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,China;Nanjing Jiangbei New Area Public Health Service Center,Nanjing 210044,China)

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,南京210008 [2]南京中医药大学附属中西医结合医院神经外科,南京210028 [3]南京市江北新区公共卫生服务中心,南京210044

出　　处：《中华神经外科杂志》2025年第1期68-72,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨血管压迫类型对经皮球囊压迫术(PBC)治疗原发性三叉神经痛(TN)效果的影响。方法回顾性分析2020年1月至2021年9月在南京大学医学院附属鼓楼医院神经外科首次接受PBC治疗的原发性TN患者的临床资料。根据术前三维时间飞跃法磁共振血管成像检查结果显示的压迫三叉神经的血管数目和特征进行分组:多支血管或大血管压迫者为复杂组,非多支血管及非大血管压迫者为简单组。比较两组患者的基线资料、术前和术后以及末次随访的疼痛视觉模拟量表(VAS)评分、术后复发比例,以及手术至复发的间隔时间。采用Kaplan-Meier生存分析和多因素Cox回归模型探讨与TN患者PBC术后疼痛复发有关的因素。结果共纳入384例患者,复杂组184例(47.92%),简单组200例(52.08%)。两组患者的年龄、性别、症状侧别、疼痛累及分支、合并症的差异均无统计学意义(均P>0.05)。与简单组相比,复杂组患者的术前疼痛VAS评分更高[分别为(8.1±0.8)分和(8.6±0.9)分],初次疾病进展至手术干预的时间更短[分别为(42.7±24.1)个月和(34.5±16.8)个月](均P<0.001)。此外,复杂组较简单组2年随访终点的疼痛复发比率更高[分别为19.6%(36/184)和7.5%(15/200)](P<0.001),其6个月内[分别为3.3%(6/184)和0.5%(1/200)]、6个月至1年[分别为7.1%(13/184)和2.5%(5/200)]、1~2年[分别为9.2%(17/184)和4.5%(9/200)]疼痛复发的比率均更高(均P<0.05)。多因素Cox回归模型分析结果表明,多支血管或大血管压迫和术前疼痛VAS评分较高与患者术后疼痛复发均有关(均P<0.05),而患者的年龄、性别、症状侧别、疼痛累及分支、合并症、术后VAS评分与术后复发均无明显相关(均P>0.05)。log-rank检验结果显示,多支血管或大血管压迫与原发性TN患者较早的疼痛复发相关(P<0.001)。结论非多支血管及非大血管压迫的原发性TN患者在PBC后表现出更好的远期治愈效果,而多支血管或大Objective To investigate the influence of vascular compression types on the effect of percutaneous balloon compression(PBC)treatment for primary trigeminal neuralgia(TN).Methods The clinical data of patients with primary TN who underwent PBC treatment at the Department of Neurosurgery,Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School from January 2020 to September 2021 were retrospectively analyzed.The patients were divided into two groups based on the number and characteristics of the offending vessels for the trigeminal nerve identified by preoperative three-dimensional time-of-flight magnetic resonance angiography(TOF-MRA).Patients with multiple or large vessel compression were defined as the complex group,while those with non-multiple or non-large vessel compression were defined as the simple group.The baseline data,preoperative and postoperative visual analogue scale(VAS)scores,recurrence rate,and interval from surgery to recurrence were compared between the two groups.The factors related to pain recurrence after PBC treatment for TN patients were explored using Kaplan-Meier survival analysis and multivariate Cox regression model.Results A total of 384 patients were enrolled in this study.Among them,184(47.92%)were in the complex group,while 200(52.08%)were in the simple group.There were no significant differences in age,gender,symptom side,pain-affected branches,or comorbidities between the two groups(all P>0.05).Compared with the simple group,the patients in the complex group had higher preoperative VAS pain scores(8.1±0.8 vs.8.6±0.9),shorter time from initial onset of the disease to intervention(42.7±24.1 months vs.34.5±16.8 months),and higher recurrence rate of pain within 2 years[7.5%(15/200)vs.19.6%(36/184)](all P<0.001).In addition,the recurrence rate of pain within 6 months was higher in the complex group than in the simple group[3.3%(6/184)vs.0.5%(1/200)],as well as the recurrence rates within 6 months to 1 year[7.1%(13/184)vs.2.5%(5/200)],1-2 years[respectively 9.2%(

关 键 词：三叉神经痛 神经外科手术 复发 经皮球囊压迫术 血管压迫类型 

分 类 号：R73[医药卫生—肿瘤]