神经内镜下微血管减压术治疗面肌痉挛临床效果及面肌痉挛术后并发症发生危险因素分析
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摘要
目的探讨神经内镜下微血管减压术治疗面肌痉挛的临床效果及面肌痉挛术后并发症发生的危险因素。方法选取面肌痉挛186例,根据微血管减压术治疗方式不同将其分为观察组(126例)和对照组(60例)两组,观察组于神经内镜下行微血管减压术治疗,对照组行常规微血管减压术治疗。观察比较两组术后2周和随访1年时临床治疗效果、随访1年时复发情况及术后并发症发生情况,并对导致其术后并发症发生的相关因素进行分析。结果术后2周和随访1年时,观察组治愈率均显著高于对照组;随访1年时,观察组复发率显著低于对照组,差异均有统计学意义(P <0. 05)。观察组术后并发症发生率2. 38%显著低于对照组术后并发症发生率30. 00%,差异有统计学意义(P <0. 05)。非条件单因素分析结果显示,责任血管情况、骨窗前缘距颞骨岩部内侧面距离、硬膜下操作时间及手术方式为影响面肌痉挛患者微血管减压术治疗后并发症发生的危险因素。多因素Logistic回归分析结果显示,责任血管发出穿支血管包绕神经出髓区、骨窗前缘距颞骨岩部内侧面距离≥2. 0 cm、硬膜下操作时间≥30 min以及采用常规微血管减压术治疗为导致面肌痉挛患者微血管减压术后并发症发生的独立危险因素。结论神经内镜下微血管减压术治疗面肌痉挛临床效果显著、复发率低。责任血管发出穿支血管包绕神经出髓区、骨窗前缘距颞骨岩部内侧面距离≥2. 0 cm、硬膜下操作时间≥30 min以及采用常规微血管减压术治疗为导致面肌痉挛患者微血管减压术后并发症发生的独立危险因素。
Objective To investigate the clinical effect of microvascular decompression( MVD) under neuroendoscopic view for hemifacial spasm( HFS) and the risk factors for postoperative complications. Methods A total of 186 patients with HFS were selected and divided into observation group( n = 126) and control group( n = 60)according to different treatment options. The observation group was treated with MVD under neuroendoscopic view,and the control group was treated with conventional MVD. The clinical effects of the two groups at 2 weeks after surgery and 1-year follow-up were compared,and the recurrence and postoperative complications at 1-year follow-up were observed between the two groups. In addition,the related factors leading to postoperative complications were analyzed. Results The clinical cure rate of the observation group was significantly higher than that of the control group at 2 weeks after operation and 1-year follow-up. At 1-year follow-up,the recurrence rate was significantly lower than that of the control group,and the difference was statistically significant( P < 0. 05). The postoperative complication rate of the observation group was 2. 38%,which was significantly lower than that( 30. 00%) of the control group,and the difference was statistically significant( P < 0. 05). Unconditional single-factor logistic regression analysis found that the offending vessel condition,the distance from the anterior border of the bone window to the petrosal bone facies medialis,the duration of subdural operation and the surgical procedure were the risk factors for the complications of MVD in patients with HFS. Multivariate logistic regression analysis found that,offending vessels that branched into the perforator vessels around the nerve pulp area,the distance from the anterior border of the bone window to the petrosal bone facies medialis ≥2. 0 cm,the duration of subdural operation ≥30 min,and conventional MVD were independent risk factors for complications following MVD in patients with HFS. Conclusion MVD under neuroendoscopic view for the treatment of HFS has a significant clinical effect and lower recurrence rate. The offending vessels branched into the perforator vessels around the nerve pulp area,the distance from the anterior border of the bone window to the petrosal bone facies medialis ≥2. 0 cm,the duration of subdural operation ≥30 min,and conventional MVD are independent risk factors for complications following MVD in patients with HFS.
Objective To investigate the clinical effect of microvascular decompression( MVD) under neuroendoscopic view for hemifacial spasm( HFS) and the risk factors for postoperative complications. Methods A total of 186 patients with HFS were selected and divided into observation group( n = 126) and control group( n = 60)according to different treatment options. The observation group was treated with MVD under neuroendoscopic view,and the control group was treated with conventional MVD. The clinical effects of the two groups at 2 weeks after surgery and 1-year follow-up were compared,and the recurrence and postoperative complications at 1-year follow-up were observed between the two groups. In addition,the related factors leading to postoperative complications were analyzed. Results The clinical cure rate of the observation group was significantly higher than that of the control group at 2 weeks after operation and 1-year follow-up. At 1-year follow-up,the recurrence rate was significantly lower than that of the control group,and the difference was statistically significant( P < 0. 05). The postoperative complication rate of the observation group was 2. 38%,which was significantly lower than that( 30. 00%) of the control group,and the difference was statistically significant( P < 0. 05). Unconditional single-factor logistic regression analysis found that the offending vessel condition,the distance from the anterior border of the bone window to the petrosal bone facies medialis,the duration of subdural operation and the surgical procedure were the risk factors for the complications of MVD in patients with HFS. Multivariate logistic regression analysis found that,offending vessels that branched into the perforator vessels around the nerve pulp area,the distance from the anterior border of the bone window to the petrosal bone facies medialis ≥2. 0 cm,the duration of subdural operation ≥30 min,and conventional MVD were independent risk factors for complications following MVD in patients with HFS. Conclusion MVD under neuroendoscopic view for the treatment of HFS has a significant clinical effect and lower recurrence rate. The offending vessels branched into the perforator vessels around the nerve pulp area,the distance from the anterior border of the bone window to the petrosal bone facies medialis ≥2. 0 cm,the duration of subdural operation ≥30 min,and conventional MVD are independent risk factors for complications following MVD in patients with HFS.
引文
[1] Joo W I,Lee K J,Park H K,et al. Prognostic value of intra-operative lateral spread response monitoring during microvascular decompression in patients with hemifacial spasm[J]. J Clin Neurosci,2008,15(12):1335-1339.
[2]曾冉,王飞红,袁邦清,等.微血管减压术治疗面肌痉挛疗效分析[J].中国临床神经外科杂志,2016,21(3):175-176.
[3]李涛,程亚鹏,刘跃亭.显微血管减压术治疗三叉神经痛及面肌痉挛的临床体会[J].中西医结合心脑血管病杂志,2016,14(18):2205-2207.
[4]曲圣涛,马英,关俊宏,等.微血管减压术治疗面肌痉挛86例临床分析[J].中国医师进修杂志,2016,39(1):68-69.
[5]杜浩,黄河,宋健,等.面肌痉挛微血管减压术后并发症的相关危险因素分析[J].中国临床神经外科杂志,2016,21(5):267-269.
[6]古军.微血管减压术治疗面肌痉挛的有效性及并发症观察[J].药品评价,2016,12(12):235-236.
[7]樊文,余小祥,樊成,等.微血管减压术治疗原发性面肌痉挛的手术效果及并发症分析[J].实用临床医药杂志,2016,20(17):98-99.
[8]张聪,王丰,林元相,等.面肌痉挛微血管减压术后短期缓解作为长期疗效预测因素的探讨[J].中华医学杂志,2017,97(39):364-366.
[9]赵华,王旭辉,朱晋,等.面肌痉挛微血管减压术后迟发性面瘫的临床分析[J].中国微侵袭神经外科杂志,2016,21(1):24-26.
[10]王墨,吴明坤,张阳,等.神经电生理监测下面肌痉挛微血管减压术的临床疗效及可行性分析[J].现代生物医学进展,2017,17(29):5673-5676.
[11] Lee M H,Jee T K,Lee J A,et al. Postoperative complications of microvascular decompression for hemifacial spasm:lessons from experience of 2040cases[J]. Neurosurg Rev,2016,39(1):151-158.
[12]樊明德,王成伟,王玉亭,等.神经内镜辅助微血管减压术治疗面肌痉挛效果观察[J].山东医药,2017,57(27):64-66.
[13]陆天宇,徐武,王晶,等.显微血管减压治疗面肌痉挛术后听力异常原因分析及预防[J].立体定向和功能性神经外科杂志,2017,31(1):15-19.
[14]郝杨,于炎冰,王琦,等.显微血管减压术治疗面肌痉挛[J].中华神经外科杂志,2017,33(9):887-891.
[15]甄雪克,张黎,于炎冰.面肌痉挛显微血管减压术后听力障碍的预后及影响因素分析[J].中华神经外科杂志,2016,32(8):806-809.
[16]王波,汪平,王宏,等.微血管减压术治疗面肌痉挛的临床效果及其术后并发症分析[J].实用心脑肺血管病杂志,2016,23(6):426-428.
[17]冯巍,陈昶,袁喜平,等.微血管减压术治疗面肌痉挛31例经验[J].中国医师进修杂志,2017,40(6):552-554.
[18] Sindou M,Brinzeu A. Postoperative complications of microvascular decompression for hemifacial spasm:lessons from experience of 2040 cases comments[J].Neurosurgical Review,2016,39(1):151-158.
[19]李涛,程亚鹏,刘跃亭.显微血管减压术治疗三叉神经痛和面肌痉挛的疗效观察[J].中华全科医师杂志,2017,16(3):227-229.
[20]徐裕,徐向东,高恒.微血管减压术治疗面肌痉挛8例临床分析[J].江苏医药,2017,43(12):902-904.
[21]陈晓晨,苏少波,马峻,等.异常肌反应监测在微血管减压术治疗面肌痉挛中的作用[J].中国现代神经疾病杂志,2016,16(5):297-302.
[22]高俊,李智敏,王天宇,等.显微血管减压术治疗面肌痉挛的临床研究[J].中国微侵袭神经外科杂志,2016,21(11):500-502.
[23]权俊杰,屈建强,周乐,等.责任血管包含椎基底动脉面肌痉挛患者临床特征及微血管减压术的治疗效果[J].实用临床医药杂志,2017,20(17):9-11.
[24] Jiang C,Xu W,Dai Y,et al. Failed microvascular decompression surgery for hemifacial spasm:a retrospective clinical study of reoperations[J]. Acta Neurochir(Wien),2017,159(2):259-263.
[25]刘睿,李钦涛,齐建平. A型肉毒毒素对比面神经显微血管减压术治疗面肌痉挛的疗效观察研究[J].重庆医学,2016,45(3):417-419.
[2]曾冉,王飞红,袁邦清,等.微血管减压术治疗面肌痉挛疗效分析[J].中国临床神经外科杂志,2016,21(3):175-176.
[3]李涛,程亚鹏,刘跃亭.显微血管减压术治疗三叉神经痛及面肌痉挛的临床体会[J].中西医结合心脑血管病杂志,2016,14(18):2205-2207.
[4]曲圣涛,马英,关俊宏,等.微血管减压术治疗面肌痉挛86例临床分析[J].中国医师进修杂志,2016,39(1):68-69.
[5]杜浩,黄河,宋健,等.面肌痉挛微血管减压术后并发症的相关危险因素分析[J].中国临床神经外科杂志,2016,21(5):267-269.
[6]古军.微血管减压术治疗面肌痉挛的有效性及并发症观察[J].药品评价,2016,12(12):235-236.
[7]樊文,余小祥,樊成,等.微血管减压术治疗原发性面肌痉挛的手术效果及并发症分析[J].实用临床医药杂志,2016,20(17):98-99.
[8]张聪,王丰,林元相,等.面肌痉挛微血管减压术后短期缓解作为长期疗效预测因素的探讨[J].中华医学杂志,2017,97(39):364-366.
[9]赵华,王旭辉,朱晋,等.面肌痉挛微血管减压术后迟发性面瘫的临床分析[J].中国微侵袭神经外科杂志,2016,21(1):24-26.
[10]王墨,吴明坤,张阳,等.神经电生理监测下面肌痉挛微血管减压术的临床疗效及可行性分析[J].现代生物医学进展,2017,17(29):5673-5676.
[11] Lee M H,Jee T K,Lee J A,et al. Postoperative complications of microvascular decompression for hemifacial spasm:lessons from experience of 2040cases[J]. Neurosurg Rev,2016,39(1):151-158.
[12]樊明德,王成伟,王玉亭,等.神经内镜辅助微血管减压术治疗面肌痉挛效果观察[J].山东医药,2017,57(27):64-66.
[13]陆天宇,徐武,王晶,等.显微血管减压治疗面肌痉挛术后听力异常原因分析及预防[J].立体定向和功能性神经外科杂志,2017,31(1):15-19.
[14]郝杨,于炎冰,王琦,等.显微血管减压术治疗面肌痉挛[J].中华神经外科杂志,2017,33(9):887-891.
[15]甄雪克,张黎,于炎冰.面肌痉挛显微血管减压术后听力障碍的预后及影响因素分析[J].中华神经外科杂志,2016,32(8):806-809.
[16]王波,汪平,王宏,等.微血管减压术治疗面肌痉挛的临床效果及其术后并发症分析[J].实用心脑肺血管病杂志,2016,23(6):426-428.
[17]冯巍,陈昶,袁喜平,等.微血管减压术治疗面肌痉挛31例经验[J].中国医师进修杂志,2017,40(6):552-554.
[18] Sindou M,Brinzeu A. Postoperative complications of microvascular decompression for hemifacial spasm:lessons from experience of 2040 cases comments[J].Neurosurgical Review,2016,39(1):151-158.
[19]李涛,程亚鹏,刘跃亭.显微血管减压术治疗三叉神经痛和面肌痉挛的疗效观察[J].中华全科医师杂志,2017,16(3):227-229.
[20]徐裕,徐向东,高恒.微血管减压术治疗面肌痉挛8例临床分析[J].江苏医药,2017,43(12):902-904.
[21]陈晓晨,苏少波,马峻,等.异常肌反应监测在微血管减压术治疗面肌痉挛中的作用[J].中国现代神经疾病杂志,2016,16(5):297-302.
[22]高俊,李智敏,王天宇,等.显微血管减压术治疗面肌痉挛的临床研究[J].中国微侵袭神经外科杂志,2016,21(11):500-502.
[23]权俊杰,屈建强,周乐,等.责任血管包含椎基底动脉面肌痉挛患者临床特征及微血管减压术的治疗效果[J].实用临床医药杂志,2017,20(17):9-11.
[24] Jiang C,Xu W,Dai Y,et al. Failed microvascular decompression surgery for hemifacial spasm:a retrospective clinical study of reoperations[J]. Acta Neurochir(Wien),2017,159(2):259-263.
[25]刘睿,李钦涛,齐建平. A型肉毒毒素对比面神经显微血管减压术治疗面肌痉挛的疗效观察研究[J].重庆医学,2016,45(3):417-419.