显微外科手术治疗三叉神经痛169例临床研究  

A clinical study on microsurgical treatment for trigeminal neuralgia:A report and analysis of 169 cases

作　　者：朱宏伟[1] 李勇杰[1] 胡永生[1] 马凯[1] 张国君[1] 

机构地区：[1]首都医科大学宣武医院北京功能神经外科研究所,北京100053

出　　处：《立体定向和功能性神经外科杂志》2004年第1期22-25,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

基　　金：国家科委基金资助项目 (编号 :9692 0 0 60 5 17) ;北京市科委基金资助项目 (编号 :95 3 3 0 40 0 1)

摘　　要：目的　研究显微外科手术治疗三叉神经痛 (trigeminalneuralgia ,TN)的临床治疗效果 ;分析手术效果、并发症和随访结果 ,探讨可能的治疗机制。方法　 2 0 0 0年 12月到 2 0 0 3年 10月间 ,16 9例TN患者接受了显微外科手术 ,其中 14 9患者行微血管减压 (MVD) ,12例联合行MVD和神经根切断术 ,8例行肿瘤切除术。术前、术后进行直观模拟量表 (VisualAnalogueScales ,VAS)和McGill疼痛问卷 (McGillPainQuestionnaire)评分。患者全部进行了电话或信件随访。结果　术后疼痛消失 131例 ,疼痛减轻 36例 ,疼痛无变化 2例。按照Taha等的评估标准 ,16 9例患者中 ,12 8例治疗结果优 ,2 6例良好 ,8例中等 ,5例差 ,2例失败。术前、术后VAS评分分别为 8.86和0 .4 8;术前、术后McGill疼痛问卷评分为 5 2 .5 0和 1.94。统计结果表明手术前后疼痛改变有显著性差异。手术并发症多为暂时性。本组患者随访时间 134月 ,平均随访时间为 15 .3± 6 .5月 ,随访期间有 4例复发。结论　微血管减压解除了TN的常见病因 ,术后无面部麻木 ,完全保留了三叉神经的功能 ,是一种治疗TN的安全有效的方法。运用VAS和McGill评分进行TN疼痛强度评分 ,比简单的治疗效果分类 (如治愈 ,有效和无效 )更为客观和精确。Objective To investigate the clinical efficacy of microsurgical treatment for trigeminal neuralgia(TN).To evaluate outcomes,indications,complications and follow-up results.To analyse possible treatment machanism.Methods Between December,2000 and Octomber,2003,169 patients with TN were treated microsurgically.Of them,149 patients were treated with microvascular decompression (MVD),8 with by tumor resection,12 witn MVD combined with rhizotomy of trigeminal nerve root.Patients were followed up with telephones or letters.Results Pain was disappeared in 131 cases,relieved in 36 case,and failed in 2 cases;According to Taha standard,Of the 169 cases,128 cases was excellent,26 cases good,8 cases fair,5 cases poor,2 failed.The score of VAS is 8.86 and 0.48 before and after operation respectively.The score of McGill Pain Questionnaire is 52.50 and 1.94 respectively.Statistical results show there is significant difference after operation.Some cases have transient complications,including herpes virus infection,peripheral facial palsy and tinnitus.The follow-up period ranged from 1 to 34 months(15.3±6.5 months),4 cases experienced recurrence of pain during the following-up period.Conclusions MVD eradicates the common cause of TN.The nervous function is well maintained.MVD surgery is a safe and effective way in treating TN.

关 键 词：显微外科 手术治疗 三叉神经痛 并发症 随访 微血管减压术 

分 类 号：R745.11[医药卫生—神经病学与精神病学] R651[医药卫生—临床医学]