三叉神经痛显微手术不同术式的疗效比较

Outcome comparison of different microsurgical methods for trigeminal neuralgia

目的为提高三叉神经痛显微手术疗效,探讨不同术式对疗效和并发症的影响。方法回顾性分析85例经显微手术治疗的三叉神经痛病人的临床资料,按手术方式不同分为3组：单纯三叉神经减压组（减压组）19例,三叉神经减压合并切断组（切断组）55例,三叉神经减压合并定位毁损组（定损组）11例。比较3组近期和中期疗效,以及并发症发生率的差异。结果术后3组间并发症发生率差异均无统计学意义（P〉0.05）。64例随访6~33个月,疼痛消失率减压组为94.4%,定损组和切断组达100%,3组间差异无统计学意义（P〉0.05）;减压组未遗留面部麻木不适,切断组面部麻木不适占50%,定损组占12.5%,3组间差异有统计学意义（P〈0.05）。结论显微手术治疗三叉神经痛安全、有效。在三叉神经减压术基础上行定位毁损术,既能保证疗效,又可改善术后病人的生活质量。

Objective To study the influence of different microsurgical manners on surgical outcome and complications and improve the surgical effect of trigeminal neuralgia.Methods Clinical data of 85 patients with trigeminal neuralgia treated by microsurgery were analyzed retrospectively.All the patients were divided into 3 groups according to the surgical modality： the trigeminal neuralgia decompression group（TND group,19 patients）,TND and rhizotomy group（rhizotomy group,55）,TND and stereotactic lesioning group（lesioning group,11）.The long-term and short-term effects and complication incidence were compared between the 3 groups.Results There was no statistical difference in the incidence of complications between the 3 groups（P0.05）.Sixty-four patients were followed up for 6 to 33 months,the rate of pain disappearance was 94.4% in TND group,100% in rhizotomy group and lesioning group,and no significant difference was found between the 3 groups（P0.05）.There were no facial numbness in TND group,but there were 50% of the patients having facial numbness in rhizotomy group and 12.5% in lesioning group.There was significant difference in between the 3 groups（P0.05）.Conclusions Microsurgery is effective and safe for trigeminal neuralgia.TND together with stereotactic lesioning can not only ensure therapeutic efficacy,but also improve the life quality of the postoperative patients.