三叉神经半月节射频热凝术不同定位方法比较

Different locating methods of radiofrequency thermocoagulation for trigeminal neuralgia on semilunar ganglion

目的 探讨三种不同定位方法在三叉神经半月节射频热凝术中的治疗效果及优缺点.方法 155例患者根据定位方法的不同分为A、B、C三组,A组为CT定位下徒手穿刺卵圆孔组,B组为立体定向CT引导下穿刺卵圆孔组,C组为立体定向CT-MR图像融合直接定位半月神经节组.分别对三组患者术中情况、手术并发症、疗效及预后进行比较.结果 A组一次性穿刺成功率33.87%,显著低于B组（92.98%）、C组（100%）;术中心血管反应发生率A组48.39%,显著高于B组（14.04%）、C组（8.33%）;手术时间A组亦显著长于B、C组.手术并发症方面A组发生率33.87%,B组21.05%,C组16.67%,三组间无显著性差异,主要为面部感觉减退,其他并发症A组显著高于B、C组.预后优良率A组80.65%,显著低于B组（94.74%）、C组（100%）,术后复发率A组11.29%,显著高于B组（1.75%）、C组（0%）.结论 CT定位下徒手穿刺卵圆孔操作方法简单,但穿刺存在较大肓目性,术中患者痛苦较大,心血管反应发生率高,手术时间延长,术后并发症相对较多,术后复发率偏高.立体定向CT引导下穿刺卵圆孔定位准确,术中患者痛苦较小,术后并发症少,复发率低,但仍为间接定位方法,不能直接定位半月神经节,如患者存在卵圆孔变异则手术难度较大.立体定向图像融合技术直接精确定位三叉神经半月节及穿刺路径,消除了穿刺盲区,显著提高了穿刺的准确性和治疗效果.

Objective To explore the therapeutic efficacy and advantages and disadvantages of three different locating methods of radiofrequency thermocoagulation for trigeminal neuralgia on semilunar ganglion. Methods Based on different locating methods, 155 patients were divided into groups A, B, and C. Group A received freehand puncturing foramen ovule cranium by CT guidance, group B received puncturing foramen ovule cranium by CT-guided stereotaxis, and group C received direct determining semilunar ganglion by CT-MR image fusion stereotaxis. The intraoperative conditions, surgical complications, efficacy, and prognosis were compared among the three group. Results The success rate of first puncture was significantly lower in group A （33.87%） than in group B （92.98%） or group C （100%）. The incidence of intraoperative cardiovascular effects was 48.39% in group A and markedly greater than group B （14.04%） or group C （8.33%）. The surgical time was longer in group A in group B or C. The rate of surgical complications was 33.87% in group A, 33.87% in group B, and 16.67% in group C, mainly facial hypaesthesia, which was no significant difference. Other surgical complications were higher in group A than in group B or C. The rate of ideal prognosis was 80.65% in group A, which was significantly lower than in group B （94.74%） or group C （100%）. The postoperative recurrence rate was significantly higher in group A than in group B or C （11.29% vs. 1.75% vs. 0%）. Conclusions The method of freehand puncturing foramen ovule cranium by CT orientation is simple but existing major blindness, moreover patients have greater painful at surgery, more incidence rate of intra- operative cardiovascular reactions, surgical complications, longer surgical time, higher postoperative recur- rence rate. The method of puncturing foramen ovule cranium by CT-guided stereotaxis is accurate in localization. Patients have slight pain at surgery, less incidence rate of intraoperative cardiovascular events and surgical complications, shorter surgical time, lower postoperative recurrence rate, but the deficiency is indirect local- ization can怏, directly puncture semilunar ganglion, increasing surgical difficulties if there are variations in foramen ovule cranium. The stereotaxis image fusion technique can directly and accurately locating semilunar ganglion and puncturing path, eliminating puncturing blind areas, and significantly increasing puncture accuracy and efficacy.