微血管减压术与经皮穿刺球囊压迫术治疗对老年三叉神经痛相关指标及预后的影响  

Effects of MVD and percutaneous balloon compression on related indicators and prognosis in elderly patients with trigeminal neuralgia

作　　者：李小波[1] 谢东[2] 李波 Li Xiaobo;Xie Dong;Li Bo(Department of Cardiac Surgery,First Hospital of Hebei Medical University,Shijiazhuang 050031,Hebei Province,China)

机构地区：[1]河北医科大学第一医院心外科,石家庄050031 [2]保定市第一医院神经外科 [3]邯郸市第一医院介入血管外科

出　　处：《中华老年心脑血管病杂志》2025年第3期332-336,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河北省医学科学研究课题计划(20241335)。

摘　　要：目的比较微血管减压术(microvascular decompression,MVD)与经皮穿刺球囊压迫术(percutaneous balloon compression,PBC)治疗对三叉神经痛患者炎性因子、神经递质、氧化应激及预后的影响。方法收集2021年6月至2023年6月保定市第一医院神经外科住院的老年三叉神经痛患者130例,根据手术方式分为MVD组64例和PBC组66例。比较2组术后即刻临床疗效、手术时间、住院时间、并发症发生率、血清炎性因子[白细胞介素(interleukin,IL)-1β、IL-6、肿瘤坏死因子α(tumor necrosis factor-alpha,TNF-α)]、氧化应激指标[丙二醛、超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)]、血清神经递质[降钙素基因相关肽(calcitonin gene-related peptide,CGRP)、P物质和5-羟色胺]水平及术后1年复发率。结果MVD组与PBC组缓解率比较,差异无统计学意义(98.4%vs 97.0%,P>0.05)。MVD组手术时间、住院时间明显长于PBC组,并发症发生率明显低于PBC组,差异有统计学意义(P<0.01)。MVD组术后6 h血清IL-1β、IL-6、TNF-α、丙二醛水平明显高于PBC组,SOD、GSH-Px水平明显低于PBC组,差异有统计学意义(P<0.01)。2组术后6 h血清IL-1β、IL-6、TNF-α、丙二醛水平明显高于术前,SOD、GSH-Px、CGRP、P物质水平明显低于术前,术后3 d血清IL-1β、IL-6、TNF-α水平明显低于术前,术后1个月血清5-羟色胺水平高于术前,CGRP、P物质水平明显低于术前,差异有统计学意义(P<0.05)。2组术后1年疼痛复发率比较,差异无统计学意义(χ^(2)=1.781,P=0.182)。结论MVD和PBC均是治疗老年三叉神经痛的有效方法,可调节炎性因子、神经递质水平;MVD术后并发症发生率相对较低,而PBC有创伤小、手术时间短、住院时间短的优势。Objective To compare the effects of microvascular decompression(MVD)and percutaneous balloon compression(PBC)on inflammatory factors,neurotransmitters,oxidative stress and prognosis in the treatment of trigeminal neuralgia(TN).Methods A total of 130 elderly TN patients admitted in Department of Neurosurgery of Baoding First Hospital from June 2021 to June 2023 were enrolled,and according to surgical approaches,they were divided into MVD group(64 patients)and PBC group(66 patients).The following indicators were compared between the two groups,including immediate postoperative clinical efficacy,operation time,length of hospital stay,incidence of complications,recurrence rate 1 year after surgery,serum inflammatory factors(Il-1β,IL-6,TNF-α),oxidative stress indicators(MAD,SOD,GSH-Px),and serum neurotransmitter[calcitonin gene-related peptide(CGRP),substance P,5-HTJ.Results There was no significant difference in remission rate between the MVD group and PBC group(98.4%vs 97.0%,P>0.05).But the MVD group had obviously longer operation time and length of hospital stay,and lower incidence of complications than the PBC group(P<o.01).Serum levels of IL-1β,IL-6,TNF-αand MAD in the MVD group at 6 h after operation were significantly higher while SOD and GSH-Px levels were significantly lower than those in the PBC group(P<o.01).Compared with the levels before surgery,both groups had significantly increased serum levels of IL-1β,IL-6,TNF-αand MAD but reduced SOD,GSH-Px,CGRP and substance P levels at 6 h after surgery,declined IL-1β,IL-6 and TNF-αlevels at 3 d after surgery,and elevated serum 5-HT level but decreased CGRP and substance P levels at 1 month after surgery(P<0.05).No statistical difference was seen in pain recurrence rate between the two groups at l year after surgery(χ^(2)=1.781,P=0.182).Conclusion Both MVD and PBC are effective treatments for senile trigeminal neuralgia,and can regulate the inflammatory factor and neurotransmitter levels.MVD has the advantage of lower incidence of postoperative complicati

关 键 词：微血管减压术 三叉神经痛 氧化性应激 预后 

分 类 号：R651.3[医药卫生—外科学]