原发性三叉神经痛的外科治疗

Surgical treatment of secondary trigeminal neuralgia

目的:明确三叉神经的解剖与外科治疗的相关关系,从而有效地干预三叉神经痛。资料来源:应用计算机检索Medline,Embase1977/2004期间与三叉神经痛相关的文献,检索词为“Trigeminalneuralgia”。同时检索CHKD期刊全文库1994/2004期间相关文章,检索词为“三叉神经痛”。限定文章语言种类为英文及中文。资料选择:对资料进行初审,选取涉及三叉神经解剖及外科治疗相关的文章,共收集到有关三叉神经痛治疗的文章1327篇,对外科治疗三叉神经痛相关文献查找全文,然后筛除明显不随机临床试验,重点引用文献20篇。资料提炼:对于检索到的关于三叉神经痛外科治疗的研究文章中相关信息进行归类分析。常用的治疗方法有:三叉神经根微血管减压术、经皮三叉神经半月节穿刺术(射频温控热凝术、注射甘油或无水乙醇)及立体定向放射治疗(γ刀或X刀)。资料综合:三叉神经痛治疗的理论与技术的发展速度很快,近年有了很多新的研究与进展,外科治疗包括手术、徒手穿刺及γ刀等的治疗。这都为三叉神经痛的治疗提供了很好的治疗思路,为总结出有效、安全、复发率低的治疗方法提供数据。结论:对于三叉神经痛的治疗,其镇痛率高、复发率低、并发症少是目前治疗的目标,各种外科治疗手段各有优缺点。按实际情况选用不同的治疗方法。

OBJECTIVE:To study the association between trigeminal anatomy and surgical treatment, so as to treat trigeminal neuralgia effectively.DATA SOURCES:Using the key terms “ Trigeminal neuralgia',we searched the MEDLINE database and Embase database for the relevant articles about trigeminal neuralgia published from 1997 to 2004 in English. Meanwhile, using the same key terms in Chinese, we searched the CHKD journals full text database from 1994 to 2004. STUDY SELECTION: All articles were selected firstly,and those were relevant to trigeminal anatomy and surgical treatment were selected. A total of 1 327 articles related to medical treatment of trigeminal neuralgia were collected, and the full text was looked up.Then the obvious non randomized clinical trials were excluded,and mainly 20 important articles were quoted.DATA EXTRACTION:The associative information from the research papers on trigeminal neuralgia treatment were analyzed.From these papers we found the main medical treatment methods were microvascular decompression,trigeminal ganglion semilunare puncture through skin(radio frequency temperature controlling thermo coagulation therapy, injection of glycerin or anhydrous alcohol) and sterotactic radioneurosurgery(γ ray of X ray).DATA SYNTHESIS:The theory and technology of treatment on trigeminal neuralgia develops fast.In recent years, many new research results and progress have been obtained.Surgical treatment includes surgical operation,bare handed puncture,and Gamma Knife,etc.All these provide good clew to treat trigeminal neuralgia,in order to provide data for summarizing an effective, safe, and low relapse rate treatment method.CONCLUSION:The present target for trigeminal neuralgia treatment is to realize high rate of pain removing and low rate of relapse, and minimize complication. Each kind of surgical treatment has its own advantages.Optimal medical treatment effect can be obtained by selecting different treatment method according to the different situation.