全程减压与常规微血管减压治疗面肌痉挛的对比研究

Comparison between whole-range and traditional microvascular decompression for the treatment of hemifacial spasm

目的探讨面神经异常肌反应监测下全程减压与常规微血管减压治疗面肌痉挛的显微手术技术和手术疗效。方法回顾性分析2003年7月至2010年3月采用两种方法治疗的1 860例面肌痉挛患者的临床资料。按手术方式不同分为A、B两组,A组650例,采用常规面神经出脑干区(REZ)微血管减压术治疗;B组1 210例,在面神经异常肌反应监测下行全程减压术。结果 A组:手术疗效:术后症状缓解共582例(89.53%),无效68例(10.46%);术后并发症:面瘫24例(3.69%),耳鸣、听力下降31例(4.76%),吞咽困难、呛咳3例。B组,手术疗效:术后症状缓解共1 185例(98%),无效25例(2.07%);术后并发症:面瘫46例(3.80%),耳鸣、听力下降76例(6.28%),吞咽困难、呛咳3例。B组与A组相比,治愈率有显著性差异(P<0.01),并发症发生率无显著差异(P>0.05)。结论面肌异常肌反应监测下对面神经根全程充分减压,在未增加并发症的情况下能有效提高治愈率。

Objective To investigate the effect of whole-range and the traditional microvascular decompression（MVD） for the treatment of hemifacial spasm（HFS） under abnormal muscle response（AMR） monitoring.Methods A total of 1 860 patients of HFS were reviewed between July 2003 and March 2010.The patients were divided into group A（650 patients） and group B（1 210 patients）.The patients of group A underwent traditional MVD and that of group B were performed with whole-range MVD with AMR monitoring.ResultsIn group A,the symptom relief was achieved in 582 cases（89.53%）.Sixty-eight cases（10.46%） were invalid.The complications included 24 cases of facial paralysis（3.69%）,31 cases of tinnitus or hearing impairment（4.76%）,and 3 cases of bucking and dysphagia.In group B,the symptoms relief was achieved in 1 185 cases（97.93%）.Twenty-five cases（10.46%） were invalid.The complications included 46 cases（3.69%）of facial paralysis,76 cases（6.28%） of tinnitus or hearing impairment,and 3 cases of bucking and dysphagia.The results indicated that the symptom relief rate in two groups was significant different（P〈0.01）,but there was no significant difference in the occurrence of complications（P〉0.05）.Conclusion Whole-range MVD with the intra-operative AMR monitoring can increase the rate of symptom relief obviously without the increase of complications.