微血管减压术与经皮穿刺球囊压迫治疗复发三叉神经痛的疗效比较
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摘要
目的探讨微血管减压术(MVD)与经皮穿刺球囊压迫(PBC)治疗MVD术后复发三叉神经痛的临床疗效。方法回顾性分析2009年1月至2016年1月分别采用MVD(25例,MVD组)与PBC(67例,PBC组)治疗的MVD术后复发三叉神经痛患者的临床资料,比较两组患者的手术疗效、手术时间、住院时间及并发症。结果 MVD组和PBC组的有效率分别为96.0%和94.0%,两组比较差异无统计学意义(P>0.05);MVD组治愈率高于PBC组(88.0%vs 64.2%,P<0.05);PBC组复发率高于MVD组(27.0%vs4.2%,P<0.05);MVD组手术时间及住院时间长于PBC组[(102.0±28.2)min vs(20.9±10.6)min,(11.7±3.5)d vs(4.3±1.8)d,均P<0.05);PBC组三叉神经抑制反应、面部麻木发生率高于MVD组(26.9%vs4.0%,92.5%vs 16.0%,均P<0.05);MVD组与PBC组口角疱疹发生率比较差异无统计学意义(32.0%vs40.3%,P>0.05)。PBC组出现咀嚼肌乏力37例;MVD组发生切口感染1例,术侧耳鸣1例。结论 MVD和PBC均能有效治疗MVD术后复发三叉神经痛。MVD的治愈率高,复发率低,三叉神经抑制反应、面部麻木、咀嚼肌乏力等并发症少;而PBC具有安全性高、创伤小、手术时间及住院时间短的优点。
Objective To compare the effect of microvascular decompression( MVD) versus percutaneous balloon compression( PBC) for recurrent trigeminal neuralgia after MVD. Methods The clinical data of 92 patients o with recurrent trigeminal neuralgia after MVD,in whom 25 were treated by MVD( MVD group),and 67 by PBC( PBC group) from January 2009 to January 2016,were analyzed retrospectively. The therapeutic efficacy,operation time,inpatient time and complications were compared between two groups. Results There were no significant differences in overall effective rate between two groups( 96. 0% vs. 94. 0%,P > 0. 05). However,the curative rate in MVD group was higher than that in PBC group( 88. 0% vs. 64. 2%,P < 0. 05). The recurrence rate was higher in PBC group than in MVD group( 27. 0% vs. 4. 2%,P < 0. 05). The operation time and hospital stay in MVD group was longer than that in PBC group [( 102. 0 ± 28. 2) min vs.( 20. 9± 10. 6) min,( 11. 7 ± 3. 5) d vs.( 4. 3 ± 1. 8) d,all P < 0. 05). The incidence of trigeminal depressor response and facial numbness was significantly greater in PBC group than MVD group( 26. 9% vs. 4. 0%,92. 5% vs. 16. 0%,all P < 0. 05). There was no significant differences of herpetic stomatitis in both groups( 32. 0 % vs. 40. 3%,P > 0. 05). 37 patients had masseter weakness in PBC group. One patient had surgical incision infection and one patient had tinnitus inMVD group. Conclusions MVD and PBC both are effective in treatment of recurrent trigeminal neuralgia after MVD. The MVD is higher cure rate,lower pain recurrence rate and lower incidence of trigeminal depressor response,facial numbness and masseter weakness. The PBC has the higher security,minimal injury,shorter operation time and inpatient time.
Objective To compare the effect of microvascular decompression( MVD) versus percutaneous balloon compression( PBC) for recurrent trigeminal neuralgia after MVD. Methods The clinical data of 92 patients o with recurrent trigeminal neuralgia after MVD,in whom 25 were treated by MVD( MVD group),and 67 by PBC( PBC group) from January 2009 to January 2016,were analyzed retrospectively. The therapeutic efficacy,operation time,inpatient time and complications were compared between two groups. Results There were no significant differences in overall effective rate between two groups( 96. 0% vs. 94. 0%,P > 0. 05). However,the curative rate in MVD group was higher than that in PBC group( 88. 0% vs. 64. 2%,P < 0. 05). The recurrence rate was higher in PBC group than in MVD group( 27. 0% vs. 4. 2%,P < 0. 05). The operation time and hospital stay in MVD group was longer than that in PBC group [( 102. 0 ± 28. 2) min vs.( 20. 9± 10. 6) min,( 11. 7 ± 3. 5) d vs.( 4. 3 ± 1. 8) d,all P < 0. 05). The incidence of trigeminal depressor response and facial numbness was significantly greater in PBC group than MVD group( 26. 9% vs. 4. 0%,92. 5% vs. 16. 0%,all P < 0. 05). There was no significant differences of herpetic stomatitis in both groups( 32. 0 % vs. 40. 3%,P > 0. 05). 37 patients had masseter weakness in PBC group. One patient had surgical incision infection and one patient had tinnitus inMVD group. Conclusions MVD and PBC both are effective in treatment of recurrent trigeminal neuralgia after MVD. The MVD is higher cure rate,lower pain recurrence rate and lower incidence of trigeminal depressor response,facial numbness and masseter weakness. The PBC has the higher security,minimal injury,shorter operation time and inpatient time.
引文
[1]舒凯,程立冬,王元星,等.显微血管减压术治疗单纯静脉压迫性三叉神经痛[J].中华神经外科杂志,2014,30:508.
[2]种衍军,陈剑,王召平,等.三叉神经痛显微血管减压术后长期疗效及复发因素分析[J].中华神经外科杂志,2011,27:449.
[3]赵长地,孔姣.微血管减压术治疗复发三叉神经痛与再手术分析[J].临床神经外科杂志,2005,2:16.
[4]Mullan S,Lichtor T.Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia[J].J Neurosurg.1983,59:1007.
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[6]Cho DY,Chang CG,Yc W,et al.Repeat operations in failed microvascular decompression for trigeminal neuralgia[J].J Neurosurg,1994,35:665.
[7]Matsushima T,Yamaguchi T,Inoue TK,et al.Recurrent trigeminal neuralgia after microvascular decompression using an interposing technique.Teflon felt adhesion and the sling retraction technique[J].Acta Neurochir(Wien),2000,142:557.
[8]Barker FG,Jannetta PJ,Bissonette DJ,et al.The long-term outcome of microvascular decompression for trigeminal neuralgia[J].N Engl J Med,1996,334:1077.
[9]于炎冰,张黎,徐晓利,等.显微血管减压术后复发三叉神经痛的手术治疗[J].中华神经外科杂志,2006,22:538.
[10]Tatli M,Satici O,Kapolat Y.Various surgical modalities for trigeminal neuralgia:literature study of respective long-tem outcomes[J].Acta Neumchir(Wien),2008,150:243.
[11]杜垣锋,杨定博,俞文华,等.经皮穿刺球囊压迫半月节治疗微血管减压术后复发性三叉神经痛[J].医学研究杂志,2014,43:118.
[12]沈永锋,王鼎,杨定博,等.二次经皮穿刺球囊压迫治疗初次球囊术后复发性三叉神经痛[J].医学研究杂志,2016,45:69.
[13]江力,俞文华,王清,等.神经内镜辅助微血管减压术治疗三叉神经痛[J].临床神经外科杂志,2012,9:349.
[14]荣道建,杨晓健,赵俊伟,等.神经内镜辅助原发性三叉神经痛显微血管减压术[J].临床神经外科杂志,2015,12:89.
[15]Castellazzi M,Tamborino C,De Santis G,et al.Timing of serum active MMP-9 and MMP-2 levels in acute and subacute phases after spontaneous intracerebral hemorrhage[J].Acta Neurochir Suppl,2010,106:137.
[16]唐四强,漆松涛,刘忆,等.原发性三叉神经痛显微血管减压术后复发相关因素的研究[J].中华神经外科杂志,2014,30:1046.
[17]贺晓生,李娜,梁景文,等.神经电生理监测在三叉神经微血管减压术中的警示作用[J].中华医学杂志,2015,95:1651.
[18]Asplund P,Linderoth B,Bergenheim AT.The predictive power of balloon shape and change of sensory functions on outcome of percutaneous balloon compression for trigeminal neuralgia[J].J Neurosurg,2010,113:498.
[2]种衍军,陈剑,王召平,等.三叉神经痛显微血管减压术后长期疗效及复发因素分析[J].中华神经外科杂志,2011,27:449.
[3]赵长地,孔姣.微血管减压术治疗复发三叉神经痛与再手术分析[J].临床神经外科杂志,2005,2:16.
[4]Mullan S,Lichtor T.Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia[J].J Neurosurg.1983,59:1007.
[5]Sekula RF Jr,Frederickson AM,Jannetta PJ,et al.Microvascular decompression for elderly patients with trigeminal neuralgia:a prospective study and systematic review with meta-analysis[J].J Neurosurg,2011,114:172.
[6]Cho DY,Chang CG,Yc W,et al.Repeat operations in failed microvascular decompression for trigeminal neuralgia[J].J Neurosurg,1994,35:665.
[7]Matsushima T,Yamaguchi T,Inoue TK,et al.Recurrent trigeminal neuralgia after microvascular decompression using an interposing technique.Teflon felt adhesion and the sling retraction technique[J].Acta Neurochir(Wien),2000,142:557.
[8]Barker FG,Jannetta PJ,Bissonette DJ,et al.The long-term outcome of microvascular decompression for trigeminal neuralgia[J].N Engl J Med,1996,334:1077.
[9]于炎冰,张黎,徐晓利,等.显微血管减压术后复发三叉神经痛的手术治疗[J].中华神经外科杂志,2006,22:538.
[10]Tatli M,Satici O,Kapolat Y.Various surgical modalities for trigeminal neuralgia:literature study of respective long-tem outcomes[J].Acta Neumchir(Wien),2008,150:243.
[11]杜垣锋,杨定博,俞文华,等.经皮穿刺球囊压迫半月节治疗微血管减压术后复发性三叉神经痛[J].医学研究杂志,2014,43:118.
[12]沈永锋,王鼎,杨定博,等.二次经皮穿刺球囊压迫治疗初次球囊术后复发性三叉神经痛[J].医学研究杂志,2016,45:69.
[13]江力,俞文华,王清,等.神经内镜辅助微血管减压术治疗三叉神经痛[J].临床神经外科杂志,2012,9:349.
[14]荣道建,杨晓健,赵俊伟,等.神经内镜辅助原发性三叉神经痛显微血管减压术[J].临床神经外科杂志,2015,12:89.
[15]Castellazzi M,Tamborino C,De Santis G,et al.Timing of serum active MMP-9 and MMP-2 levels in acute and subacute phases after spontaneous intracerebral hemorrhage[J].Acta Neurochir Suppl,2010,106:137.
[16]唐四强,漆松涛,刘忆,等.原发性三叉神经痛显微血管减压术后复发相关因素的研究[J].中华神经外科杂志,2014,30:1046.
[17]贺晓生,李娜,梁景文,等.神经电生理监测在三叉神经微血管减压术中的警示作用[J].中华医学杂志,2015,95:1651.
[18]Asplund P,Linderoth B,Bergenheim AT.The predictive power of balloon shape and change of sensory functions on outcome of percutaneous balloon compression for trigeminal neuralgia[J].J Neurosurg,2010,113:498.