显微外科手术治疗三叉神经痛的随访研究

Microsurgery for Trigeminal Neuralgia: Following-up Results of 181 Patients

目的探讨显微外科手术治疗三叉神经痛的临床效果。方法181例三叉神经痛患者中,121为典型性三叉神经痛,60例为非典型性三叉神经痛;160例存在血管神经压迫者采用微血管减压术(MVD)治疗,21例无明显血管压迫者采用三叉神经部分感觉根切断术(PSR)治疗;术后随访1～6年(平均42个月)。结果随访期末,行MVD者15例(9.4%)三叉神经痛复发,行PSR者6例(28.6%)复发;两者复发率相差显著(P<0.05)。典型性三叉神经痛患者预后明显好于非典型性患者(P<0.05);老年组(>60岁)和年轻组(<60岁)患者术后并发症的发生率无明显差别(P>0.05);病程、临床症状、神经血管压迫与术后三叉神经痛复发呈正相关(P<0.05)。结论对于有明显血管压迫的三叉神经痛患者MVD治疗是安全有效的,对于没有血管压迫的三叉神经痛患者手术策略仍需进一步的研究。病程、临床症状、神经血管压迫可能在三叉神经痛复发中起重要作用。

Objective To explore the clinical effect of microsurgery on trigeminal neuralgia （TN）. Methods Of 181 patients with TN, 121 suffered from typical TN and 60 atypical TN. The microvascular decompression（MVD） and partial sensory rhizotomy（PSR） of trigeminal nerve were performed in 181 patients with TN, who were postoperatively followed up from 1 to 6 years （mean, 42 months）. Results The following up showed that the recurrence rate （9,49%） in 160 patients undergoing MVD was significantly lower than that （28.6%） in 21 patients undergoing PSR （P〈0.05）. The rate of good prognosis in the patients with typical TN was significantly higher than that in the patients with atypical TN （P〈0.05）. There was insignificant difference in occurrence rate of operative complication between old patients and young patients （P〉0.05）. The disease process, clinical manifestation and vascular compression of the trigeminal root were positively related to the recurrence of TN. Conclusions MVD is a safe and effective method to treat TN induced by vascular compression. The operative method to treat with TN without vascular compression should be further developed. The disease process, clinical manifestation and vascular compression of the trigeminal root may play roles in the recurrence of TN.