改良射频温控热凝术治疗原发性三叉神经痛疗效观察
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摘要
目的探讨微创手术治疗原发性三叉神经痛的可行性和有效性。方法选取自2015年1月至2016年12月沈阳军区总医院收治的30例原发性三叉神经痛患者为研究对象,经颌下-卵圆孔入路穿刺,行半月神经节射频温控热凝术治疗,观察术后患者疼痛的缓解程度。结果本组30例患者中,术后即刻疼痛缓解27例,3例经服用小剂量卡马西平3~7 d疼痛消失。术后1年,1例患者复发,临床总有效率为96.7%(29/30)。本组30例患者均出现病变区域皮肤麻木感,眼角膜均未受累。其中,6例患者咀嚼力减退,并发症的发生率为20.0%(6/30)。结论采用颌下-卵圆孔入路穿刺方法行射频温控热凝术治疗三叉神经痛安全可靠,疗效满意。
Objective To investigate the feasibility and efficiency of a minimally invasive treatment of trigeminal neuralgia.Methods A retrospective study was performed on 30 cases of patients with primary trigeminal neuralgia who were admitted from January 2015 to December 2016. Patients were treated with radiofrequency thermocoagulation through submandibullar region and foramen ovale approach to gassers ganglation,the pain relief of postoperative patients was observed. Results All the 30 patients in this group,27 had immediate postoperative pain relief,and 3 patients had disappeared after taking small dose carbamazepine for 3-7 days. One year after surgery,1 patient recurred,and the total clinical effective rate was 96. 7%(29/30). All the 30 patients in this group showed skin numbness in the lesion area and the cornea was not involved. The incidence of complications was 20. 0%(6/30).Conclusion The minimally invasive treatment of trigeminal neuralgia through submandibullar region and foramen ovale approach is satisfactory,safe and reliable,which is worth of clinical promotion.
Objective To investigate the feasibility and efficiency of a minimally invasive treatment of trigeminal neuralgia.Methods A retrospective study was performed on 30 cases of patients with primary trigeminal neuralgia who were admitted from January 2015 to December 2016. Patients were treated with radiofrequency thermocoagulation through submandibullar region and foramen ovale approach to gassers ganglation,the pain relief of postoperative patients was observed. Results All the 30 patients in this group,27 had immediate postoperative pain relief,and 3 patients had disappeared after taking small dose carbamazepine for 3-7 days. One year after surgery,1 patient recurred,and the total clinical effective rate was 96. 7%(29/30). All the 30 patients in this group showed skin numbness in the lesion area and the cornea was not involved. The incidence of complications was 20. 0%(6/30).Conclusion The minimally invasive treatment of trigeminal neuralgia through submandibullar region and foramen ovale approach is satisfactory,safe and reliable,which is worth of clinical promotion.
引文
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[2]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.
[3]Koopman JS,de Vries LM,Dieleman JP,et al.A nationwide study of three invasive treatments for trigeminal neuralgia[J].Pain,2011,152(3):507-513.
[4]李杰,王卓.改良显微血管减压术治疗原发性三叉神经痛的疗效分析[J].检验医学与临床,2018,15(7):903-905.
[5]李强,李玉,邓兴力.原发性三叉神经痛的临床治疗进展[J].临床神经外科杂志,2014,12(5):393-396.
[6]庞惠泽,范国光.原发性三叉神经痛形态学及功能改变的MRI研究现状与进展[J].国际医学放射学杂志,2018,41(1):35-38.
[7]Bahgat D,Ray DK,Raslan AM,et al.Trigeminal neuralgia in young adults[J].J Neurosurg,2011,114(5):1306-1311.
[8]肖伟波,蒋劲,张德仁.原发性三叉神经痛的微创手术治疗进展[J].实用疼痛学杂志,2010,6(4):294-297.
[9]唐飞虎.DSA下半月神经节射频毁损术治疗原发性三叉神经痛的效果研究[J].医学信息,2018,31(1):96-97.
[10]郑淑月,王晓宇,赵颖,等.CT引导下经皮三叉神经射频热凝术治疗原发性三叉神经痛对咀嚼肌功能的影响[J].中国康复医学杂志,2015,30(1):44-46.
[11]王燕,华泽权,李欣欣,等.CT三维成像精确定位卵圆孔行射频热凝术治疗原发性三叉神经痛的疗效分析[J].中国康复医学杂志,2012,27(7):616-620.
[12]李忠铭,季璐璐.射频温控热凝治疗原发性三叉神经痛27例临床分析[J].交通医学,2016,30(6):613-614.
[13]刘垒,吴承远,于明光,等.三维CT导向卵圆孔精确定位射频热凝治疗三叉神经痛研[J].中国疼痛医学杂志,2007,6:323-326.