原发性三叉神经痛微血管减压术后复发的影响因素分析
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摘要
目的探讨微血管减压术(MVD)治疗原发性三叉神经痛(PTN)的疗效及术后复发的影响因素。方法回顾性分析2014年1月至2017年1月MVD治疗的164例PTN的临床资料。术后随访12～48个月,中位随访时间31个月。采用巴罗神经学研究所(BNI)面部疼痛分级标准评估疗效。采用多因素Logistic回归分析检验术后复发的影响因素。结果术后1周BNI分级Ⅰ～Ⅱ级139例(84.76%),Ⅲ级25例(15.24%);术后11例(6.70%)出现并发症。随访期间共复发31例,复发率为18.90%。多因素Logistic回归分析显示,病程≥5年、减压未充分、压迫有移位是影响PTN病人MVD后复发的独立危险因素(P<0.05)。结论 MVD治疗PTN临床疗效确切,安全性较高;对于病程长、未充分减压的病人,应注意加强随访,防治复发。
Objective To explore the factors related to the recurrence of primary trigeminal neuralgia(PTN) after microvascular decompression(MVD). Methods The clinical data of 164 patients with PTN who underwent MVD in department of neurosurgery of our hospital from January, 2014 to January, 2017 were analyzed retrospectively. The factors related to the recurrence were statistically analyzed in the patients. Results The facial pain belonged in grades Ⅰ～Ⅱ in 139 patients(84.76%) and grades Ⅲ 25(15.24%) 1 weeks after MVD according to Barow Neurological Institute pain grade. There were the postoperative complications including facial numbers,herps of corners of the mouths, hearing disturbance and taste deficiency in 11 patients. The trigeminal recurred 12～48 months after MVD in 31 patients. Multivariable Logistic regression analysis showed that the independent risk factors related to the recurrence included the disease duration≥5 years, insufficient decompression, and displacement of compression in patients with PTN(P<0.05). Conclusions The curative effect of MVD on PTN and its safety are good. It is necessary to pay high attention to the risk factors related to the recurrence in the patients with PTN.
Objective To explore the factors related to the recurrence of primary trigeminal neuralgia(PTN) after microvascular decompression(MVD). Methods The clinical data of 164 patients with PTN who underwent MVD in department of neurosurgery of our hospital from January, 2014 to January, 2017 were analyzed retrospectively. The factors related to the recurrence were statistically analyzed in the patients. Results The facial pain belonged in grades Ⅰ～Ⅱ in 139 patients(84.76%) and grades Ⅲ 25(15.24%) 1 weeks after MVD according to Barow Neurological Institute pain grade. There were the postoperative complications including facial numbers,herps of corners of the mouths, hearing disturbance and taste deficiency in 11 patients. The trigeminal recurred 12～48 months after MVD in 31 patients. Multivariable Logistic regression analysis showed that the independent risk factors related to the recurrence included the disease duration≥5 years, insufficient decompression, and displacement of compression in patients with PTN(P<0.05). Conclusions The curative effect of MVD on PTN and its safety are good. It is necessary to pay high attention to the risk factors related to the recurrence in the patients with PTN.
引文
[1]权俊杰,屈建强,周乐,等.微血管减压术与感觉根部分切断术联合治疗原发性三叉神经痛效果观察[J].解放军医药杂志,2016,28(1):73-76.
[2]张斌,张良文,迟令懿,等.显微血管减压术治疗原发性三叉神经痛疗效的相关因素[J].山东大学学报:医学版,2016,54(6):69-72.
[3]杜权,俞文华,胡强.微血管减压术联合电凝术与单纯微血管减压术治疗原发性三叉神经痛的疗效比较[J].浙江医学,2016,38(5):329-331.
[4]张萌萌,王玲.三叉神经痛病人行显微外科微血管减压术治疗的临床效果及护理配合[J].实用临床医药杂志,2016,20(20):53-55.
[5]苏忠周,周跃,沈健,等.微骨孔枕下乙状窦后入路显微血管减压术治疗45例三叉神经痛[J].中华显微外科杂志,2016,39(5):481-483.
[6]方立,单国用,张松,等.伽玛刀治疗三叉神经痛显效、复发时间及安全性的生存分析[J].国际神经病学神经外科学杂志,2017,44(3):252-256.
[7]Alves TC, Azevedo GS, Carvalho ES. Pharmacological treatment of trigeminal neuralgia:systematic review and metanalysis[J]. Rev Bras Anestesiol, 2004, 54(6):836-849.
[8]Han PP, Shetter AG, Smith KA, et al. Gamma knife radiosurgery for trigeminal neuralgia:experience at the Barrow Neurological Institute.[J]. Stereotact Funct Neurosurg, 2000,47(4):1013-1019.
[9]刘厚强,孟庆明,叶成坤,等.微血管减压术治疗原发性三叉神经痛预后影响因素分析[J].中华神经医学杂志,2018,17(4):402-405.
[2]张斌,张良文,迟令懿,等.显微血管减压术治疗原发性三叉神经痛疗效的相关因素[J].山东大学学报:医学版,2016,54(6):69-72.
[3]杜权,俞文华,胡强.微血管减压术联合电凝术与单纯微血管减压术治疗原发性三叉神经痛的疗效比较[J].浙江医学,2016,38(5):329-331.
[4]张萌萌,王玲.三叉神经痛病人行显微外科微血管减压术治疗的临床效果及护理配合[J].实用临床医药杂志,2016,20(20):53-55.
[5]苏忠周,周跃,沈健,等.微骨孔枕下乙状窦后入路显微血管减压术治疗45例三叉神经痛[J].中华显微外科杂志,2016,39(5):481-483.
[6]方立,单国用,张松,等.伽玛刀治疗三叉神经痛显效、复发时间及安全性的生存分析[J].国际神经病学神经外科学杂志,2017,44(3):252-256.
[7]Alves TC, Azevedo GS, Carvalho ES. Pharmacological treatment of trigeminal neuralgia:systematic review and metanalysis[J]. Rev Bras Anestesiol, 2004, 54(6):836-849.
[8]Han PP, Shetter AG, Smith KA, et al. Gamma knife radiosurgery for trigeminal neuralgia:experience at the Barrow Neurological Institute.[J]. Stereotact Funct Neurosurg, 2000,47(4):1013-1019.
[9]刘厚强,孟庆明,叶成坤,等.微血管减压术治疗原发性三叉神经痛预后影响因素分析[J].中华神经医学杂志,2018,17(4):402-405.