改良Hartel入路在半月节射频热凝术治疗原发性三叉神经痛的疗效及安全性分析

Efficacy and safety of modified Hartel approach in the treatment of primary trigeminal neuralgia with radiofrequency thermocoagulation

目的评估改良Hartel入路在半月节射频热凝术治疗原发性三叉神经痛的疗效和安全性。方法前瞻性纳入徐州医科大学鼓楼临床学院2021年7月至2022年7月共89例原发性三叉神经痛患者,按照随机数字表法分为试验组(n=45)和对照组(n=44)。试验组男19例,女26例,年龄(67.6±8.8)岁;在CT引导下,采用改良Hartel入路行经卵圆孔半月节射频热凝术,选取口角外2.0 cm、下1.0 cm作为进针点。对照组男19例,女25例,年龄(64.8±11.7)岁;在CT引导下,采用传统Hartel入路行经卵圆孔半月节射频热凝术,选取口角外2.5 cm为进针点。记录并比较两组患者的一次穿刺成功率、穿刺次数、穿刺时间、手术时间、疼痛数字评分(NRS)和手术并发症发生率的差异。结果试验组一次穿刺成功率为64.4%(29/45),高于对照组的31.8%(14/44)(P<0.05)。试验组穿刺次数[M(Q_(1),Q_(3))]、穿刺时间[M(Q_(1),Q_(3))]、手术时间分别为1(1,2)次、218(206,378)s、(19.9±2.7)min,均低于对照组的2(1,3)次、390(231,598)s、(27.0±3.9)min(均P<0.05);试验组患者术后1 d、1个月、3个月的NRS评分[M(Q_(1),Q_(3))]分别为1(1,2)、1(0,2)、1(0,1)分,均低于术前的6(6,7)分(均P<0.05);对照组患者术后1 d、1个月、3个月的NRS评分[M(Q_(1),Q_(3))]分别为1(1,2)、1(0,2)、1(0,2)分,均低于术前的6(6,7)分(均P<0.05);两组患者术后同一时间点的NRS评分比较差异均无统计学意义(均P>0.05)。对照组和试验组面部肿胀发生率分别为25.0%(11/44)、8.9%(4/45),差异有统计学意义(P<0.05),两组间恶心呕吐、面部麻木、咀嚼肌力下降发生率差异均无统计学意义(均P>0.05)。试验组有2例患者穿刺针进入口腔,及时发现并更换穿刺针,未发生感染。两组患者均未发生脑脊液漏、角膜反射减弱。结论改良Hartel入路可提升经卵圆孔半月节射频热凝术的一次穿刺成功率,缩短手术时间,降低术后面部肿胀发生率,是一种安全有效的穿刺方式。

Objective To assess the efficacy and safety of modified Hartel approach in the treatment of primary trigeminal neuralgia with radiofrequency thermocoagulation.Methods A total of 89 patients with primary trigeminal neuralgia in Nanjing Drum Tower Clinical College of Xuzhou Medical University from July 2021 to July 2022 were prospectively included,and were divided into experimental group(n=45,modified Hartel approach:selecting 2.0 cm lateral to and 1.0 cm below angulus oris as insertion point)and control group(n=44,traditional Hartel approach:selecting 2.5 cm lateral to the angulus oris as insertion point)according to the random number table method.There were 19 males and 26 females in the experimental group,and aged(67.6±8.8)years.Meanwhile,there were 19 males and 25 females in the control group,and aged(64.8±11.7)years.All the patients were treated by CT-guided radiofrequency thermocoagulation.The success rate of one-time puncture,number of punctures,the time of puncture,operation time,numerical rating scale(NRS)scores and complications were recorded and compared between the two groups.Results The success rate of one-time puncture in experimental group was 64.4%(29/45),which was higher than that in control group 31.8%(14/44)(P<0.05).The number of punctures[M(Q_(1),Q_(3))],the time of puncture[M(Q_(1),Q_(3))]and operation time in the experimental group were 1(1,2),218(206,378)s,(19.9±2.7)min,which were less than those of control group[2(1,3),390(231,598)s,(27.0±3.9)min](all P<0.05).The NRS scores[M(Q_(1),Q_(3))]of 1 day,1 month and 3 months after surgery in the experimental group were 1(1,2),1(0,2)and 1(0,1),respectively,which were lower than the baseline level[6(6,7)](all P<0.05).The NRS scores[M(Q_(1),Q_(3))]of 1 day,1 month and 3 months after surgery in the control group were 1(1,2),1(0,2)and 1(0,2),respectively,which were lower than the baseline level[6(6,7)](all P<0.05).There was no statistically significant difference in the incidence of nausea and vomiting,facial numbness,and decreased masticatory muscle strength between the two groups(all P>0.05)In the experimental group,two patients had puncture needles into the oral cavity,with timely detection and replacement of puncture needles,and no infection occurred.There was no cerebrospinal fluid leakage and decreased corneal reflex in both groups.Conclusion The modified Hartel approach can significantly improve the success rate of one-time puncture via foramen ovale,reduce the operation time and the incidence of postoperative facial swelling,which is a safe and effective puncture method.