181例原发性三叉神经痛微血管减压术疗效分析

Therapeutic effect of microvascular decompression on primary trigeminal neuralgia： analysis of 181 cases

目的探讨微血管减压术在原发性三叉神经痛疗中的效果，为指导诊疗提供临床依据。方法对广东省人民医院神经外科自2000年1月至2007年12月收治的181例原发性三叉神经痛患者的一般资料、责任血管和外科手术效果等临床资料进行总结分析。结果181例三叉神经痛患者中，O型血患者79例（占43．65％），较国人正常O型血分布（33．80％）有增高趋势；发病率右侧：左侧=1．8：1；2条以上责任血管者45例（24．86％）；责任血管包括小脑上动脉96例，小脑后下动脉7例，小脑前下动脉以及动静脉混合接触或压迫者各25例，内听动脉13例，基底动脉15例，椎动脉9例，单纯静脉15例（主要为岩静脉和桥静脉），无名血管9例（主要为以上动静脉血管的分支）。181例患者术后1月内171例症状完全消失（94．48％）；症状改善，但需结合药物控制者9例（4．97％）；植物生存1例（0．55％）。结论本组资料提示O型血可能更易患三叉神经痛；微血管减压术是原发性三叉神经痛的理想治疗手段，防止遗漏多发性责任血管是减少术后复发的重要因素。

Objective To analyze the therapeutic effects of microvascular decompression on primary trigeminal neuralgia. Methods The general clinical data, culprit vessels and therapeutic effects of the surgical interventions were analyzed in 181 patients （aged from 24 to 79 years with a mean of 54.9 years, including 78 male and 103 female patients） with established diagnosis of primary trigeminal neuralgia admitted from January, 2000 to Deceber, 2007. Results Blood type O was present in 43.65% of the 181 patients with trigeminal neuralgia, which had an increasing tendency compared to the national norm （33.8%）. The morbidity ratio between the right and left side was 1.8：1 in these patients. Forty-five patients （24.86%） were identified to have more than 2 culprit vessels. The culprit vessels included the superior cerebellar artery （96 cases）, posterior inferior cerebellar artery （7 cases）, anterior inferior cerebellar artery （25 cases）, arteries communicated with veins （25 cases）, internal auditory artery （13 cases）, basilar artery （15 cases）, vertical artery （9 cases）, exclusive veins （15 cases, mainly vena petrosa and bridging vein） and unknown vessels （9 cases）. Of the 181 cases, 171 （94.48%） were cured within one month, 9 （4.97%） showed relieved symptoms but required drug therapy, and 1 was in vegetative state （0.55%）. Conclusions Patients with blood type O may have greater chance of developing primary trigeminal neuralgia. Microvascular decompression is an ideal treatment for primary trigeminal neuralgia, and clear identification of the culprit vessels can be crucial for decreasing the postoperative recurrence.